Scuba Diver Registration Application

Not all divers will qualify unfortunately. Please only Florida Divers apply.

Name of applicant
Present address
Previous address (If less than 2 years on present address)
Primary phone
Secondary phone
Email address
Which agency certified you to dive and when?
What is your current level of diver certification?
Are you a Reef Check diver?
Are you a scientific diver?
# of dives or snorkels you participated in during the last 12 months
# of dives specific to SE Florida Reef Tract (12 months)
Do you have a Divers Insurance policy?
Did you ever choose not to dive due to conditions aboard a dive boat?
How comfortable are you with drift diving?
How comfortable are you with multi-tasking underwater?
Would you claim to be a great dive buddy?
Ocean Rehab Initiative Inc. is a registered
501(c)(3) Florida non-profit organization
301 Clematis Street, Suite 3000
West Palm Beach, FL 33401
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