| Quarter Century Divers Society QCDS Membership Application |
| Mark an "X" in the type of membership you are interested in Membership type: Master _________ $15.00/year Associate ________ $10.00/year Fill out the following information completely. PRINT neatly. Name____________________________________________________ Address__________________________________________________ __________________________________________________ City _____________________________________________________ State ____________________________________________________ Zip Code _________________________________________________ E-mail ___________________________________________________ Origional Cert. agency_______________________________________ Origional Cert Date __________________________________________ =============================================================================== =============================================================================== |
| Send membership application and check (made payable to Todd DeAngelis) to: Todd DeAngelis 2158 Berryhill Street Harrisburg, PA 17104 Membership pack will be sent out within 2 weeks of recipt. |
| Click here to return to the QCDS Main page ---------> |
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| Master Members must be certified for a least 25 years. Associate Memberships are open to any certified diver that does not meet the 25 year minimum required for Master membership. If possible please include a photocopy of your origional C Card |
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