Eastern Dive Boat Association
return
to topMEMBERSHIP
APPLICATION
Print out and send to address at the end.
Your Name _____________________________________
ADDRESS
____________________________________________
City _______________________State _____Zip______________
PHONE NUMBER HOME
__________________________WORK __________________________________________
NAME OF VESSEL
___________________________________
MAKE
______________________________________________
HAILING PORT ______________________________________
VESSEL
& OWNER INFORMATION
ANSWER
ONLY QUESTIONS THAT ARE APPLICABLE
by checking the proper box or write in.
ARE YOU LICENSED ? Yes ___
No___
OCEAN OPERATOR
MBO
LICENSE
#________________
ISSUE Number __________Date _____________
ISSUED OFFICE __________________________
VESSEL MANUFACTURER ___________________Country____________
LENGTH OF VESSEL _____________Feet________
BEAM ____________ feet
TYPE OF POWER Gas
Diesel
SINGLE SCREW
TWIN SCREW
CONSTRUCTION WOOD
GLASS
OTHER
LORAN yes
no
DEPTH RECORDER yes
no
RADAR yes
no
VHF yes
no 
SSB yes
no
GPS yes
no 
SIX PACK Non inspected vessel
yes
no
COI-Certified to carry
passengers yes
no
# of passengers more
than 6 __________
Oceans cert YES ____NO_____
Miles________50 oceans ______100 Oceans
Coastwise yes
no
SAFETY EQUIPMENT yes
no
THROW LINE yes
no 
CHASE BOAT yes
no
RESCUE BOARD yes
no 
Are you a certified
diver yes
no 
Level of certification
Agency (s) ________________
Are you CPR certified yes
no
First Aid certified yes
no 
How did you hear about the
Eastern Dive Boat Association
Membership Fee $75
& Yearly dues $75.00
Mail application and check total for $150.00 to:
Captain Joe Terzuoli
3423 Woodfield Ave.
Wall, NJ.
07719
732) 681-0806
email
captzerooo@aol.com
|