Con-Ed Application

Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email address*

Phone Number*

Branch of Service*

Do you have a rating from the Veterans Administration?*

To participate in our programs at no cost, you will need to provide proof of your V.A. Rating.

Total Number of Logged Dives?*

What SCUBA Gear do you currently own?*

Which of the following Specialty Certifications do you already have?*

Please upload your Certification Card

Max. file size: 500 MB.

IF YOU RECEIVED YOUR CERTIFICATION FROM THE "WAVES PROJECT' YOU DO NOT NEED TO UPLOAD A COPY OF YOUR C-CARD

Have you participated in a WAVES Project course?*

Do you have a dive buddy that will train with you?*

Dive Buddy Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Dive Buddy Email address

Each participants must have their own unique email address

Dive Buddy Phone

Total Number of Dive Buddies Logged Dives?

Does your Dive Buddy own any of their Dive Gear?

Which of the following Specialty Certifications does your dive buddy already have?

Please upload your Certification Card

Max. file size: 500 MB.

IF YOU RECEIVED YOUR CERTIFICATION FROM THE "WAVES PROJECT' YOU DO NOT NEED TO UPLOAD A COPY OF YOUR C-CARD

Please prove you are human by selecting the truck.