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GREATER LOS ANGELES

COUNCIL OF DIVERS

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About GLACD

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Telecommunity of Divers

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 Name :     _______________________________________

Address:    _______________________________________

City/State/Zip: _____________________________________

County:       __________ Email Address: _________________  

Home Phone: _________

Affliation     __________________   Work Phone:__________

Certification Agency: ____________  Year:__________

Amount Enclosed $ _____________ 
PLEASE CHECK DESIRED Membership

GLACD INDIVIDUAL MEMBER
( )$15 (E-mail Delivery of Newsletter) or
(  )$20 Newsletter sent via US Mail
( )ADD $15 Underwater Society of America Dues (Optional)

(   ) GLACD ASSOCIATE MEMBER (BUSINESS) $35
(   ) GLACD SUPPORTIONG CLUB $35

PRINT OUT AND MAIL TO: GLACD, P.O. BOX 6255, Torrance, CA 90504
 




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