Rentals

Diver Information

Name*
Email*
Address*
City*
State*		Zip*
Home Phone
Cell Phone
Fax
Submit
* Required

Certification Information
Each diver must provide certification information.

Driver's License
Driver's License State
Social Security
Highest Certification Level to Date
Certification Number
Certification Agency
Number of Total Logged Dives
Date of last dive
Submit

'Bottoms-Up' Club Member Information

Society Member
	Information on File?
Submit

Rental Equipment
Quantities should include equipment needed for all
members of your dive party.

ITEM PRICE TOTOAL QUANTITY SIZES & QUANTITY


Mask	$5.00
Fins	$6.00	Shoe Sizes
Snorkel	$3.00
Snorkeling Vest	$6.00	Child
Snorkeling Vest	$6.00	Adult
Mask-Fins-Snorkel Package	$11.00	Shoe Sizes
Tank (Aluminum)	$8.00	80:
		63:
		50:
Tank (Aluminum 100)	$12.00
Regulator w/ Octopus	$12.00
Regulator w/ Scubapro Air II	$18.00
Scubapro Air II	$8.00
Buoyancy Compensator Jacket	$10.00	Small:
		Medium:
		Large:
Full Suit	$10.00	Small:
		Medium:
		Large:
Wet Suit Shorty 3mm	$8.00	Small:
		Medium:
		Large:
Weight Belt	$4.00	# of Pounds
Underwater Light	$7.00
Underwater Camera	$12.00
SCUBA PACKAGE (TDS - 2 Tanks, Regulator, Buoyancy Compensator, Wt. Belt, 1/2 Suit)	$38.00	Small:
		Medium:
		Large:
Dive Computer	$35.00
Flag & Float	$7.00
Underwater Scooter (Price Per Hour)	$20.00
Comments:
Submit

Diver 2 Certification Information

Driver's License
Driver's License State
Social Security
Highest Certification Level to Date
Certification Number
Certification Agency
Number of Total Logged Dives
Date of last dive
Submit

Diver 3 Certification Information

Driver's License
Driver's License State
Social Security
Highest Certification Level to Date
Certification Number
Certification Agency
Number of Total Logged Dives
Date of last dive
Submit

Diver 4 Certification Information

Driver's License
Driver's License State
Social Security
Highest Certification Level to Date
Certification Number
Certification Agency
Number of Total Logged Dives
Date of last dive
Submit