Membership Application

Dues: $30 per couple or $18 per single.

Please print this application, and either Bring it to the Next Meeting or mail it with a check or money order for your dues to us at:

Nautical Nudists Dive & Boating Club
PO Box 742
Land O Lakes FL 34639-0742

You may also pay with PayPal but you MUST specify what the payment is for.

Name (1) _______________________________________________ Name (2) _______________________________________________

Email address (1) _______________________________________ Email Address (2) _______________________________________

Address _______________________________________________________________________________________________________

City ___________________________________________________________ State ______________________ Zipcode____________

Home / Cell phone (1) ____________________________________ Home / Cell phone ___________________________________

Diving Qualification/s (1) __________________________________________ (2) ___________________________________________

Boating Qualification/s (1) _________________________________________ (2) ___________________________________________

Are You Willing to Serve on a Committee? (1) Yes No (2) Yes No

Do you Own a Boat/s? Yes No Are you willing to be Photographed? Yes No

Emergency Notification Name ____________________________________________________________________________________

Address _________________________________________________ City ________________________ State ______________________

Phone Number _________________________________________________ Relationship ____________________________________

(1) _________________________________________________________ (2) ____________________________________________________