Dallas Underwater Photographic Society

Membership Application

6534 Forest Creek Drive

Dallas, TX 75230

For more info email Barry Guimbellot barryag1@sbcglobal.net 

 

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

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How Did You Hear About This Club? _______________________________________________

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Any Comments or Suggestions: _____________________________________________________

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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: ______________________________


Dallas Underwater Photographic Society

Membership Profile

 

 

 

Name: _________________________________________________________________________

 

To what extent are you willing to get involved in the club? ______________________________

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What strengths, abilities, and possible networking would you be willing to contribute to the club?

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What do you expect to get from being a member of this type of club? _____________________

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