Dallas Underwater Photographic Society
Membership Application
6534 Forest Creek Drive
Dallas, TX 75230
For more info email Barry Guimbellot barryag1@sbcglobal.net
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Name: __________________________________________ Date:_____________________
Address: ______________________________________________ Apt
#:__________________
City: _________________________ State:____________ Zip:______________________
Home Phone: (_____ )_________________ Work Phone:
(_____ )_____________________
Fax: (______ )_________________ Email:___________________________________
Permission to release name
and address to Photo/SCUBA related mailing lists:
No________ Yes
_______ signed:_______________________________________________
Occupation:
_____________________________________________________________________
Diver Certification Organization: ________________________ Level: ___________________
Dive Trips Per Year: _____________________ Years Diving Experience:________________
Annual
Dues (check one): Individual ($30) Family ($35)
(Note: After July 1st $12.50 / $15)
If
Family Membership, Please List Names and Pertinent Information:
Name Relationship Diver
Certification Org./Level
_________________________________________________________________________________
_________________________________________________________________________________
How
Did You Hear About This Club? _______________________________________________
_________________________________________________________________________________
Any Comments or Suggestions: _____________________________________________________
_________________________________________________________________________________
Photographic Information
Experience: (Mark ‘T’ for Top Side, ‘U’ for Underwater)
Beginning:_________ Intermediate:__________ Advanced: ___________ Pro: ________
Interests: Still: ________ Video:
________
Equipment: ________________ Housed SLR: _________ Video
Cam: ____________
Movie
Camera: __________ Other: ______________________________