Please provide the following contact information in order for us to get a hold of you:

First Name
Last Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Please tell us your current age and gender:

Age
Sex	Male Female

What interests you about becoming a SWORD member; select any of the following options that apply:

Become a SWORD Public Safety Diver
Volunteer time to attend and assist with events
Help out the dive team from shore
Become a boat driver for the SWORD team
Assist with team administration duties
Volunteer to help raise money for SWORD
Donate money to the SWORD Team cause
Help to donate/sponsor/or obtain gear for the team
Press relations
I'm just curious about what you do

Choose one of the following options to best represent your current diver certification level:

Not Currently Certtified Open Water Diver Public Safety Diver Dive Rescue I or II Specialty Diver (have specialty ratings) Advnaced Open Water Diver Rescue Diver Master Scuba Diver Technical Diver Rating (Trimix etc) Dive Master Open Water Instructor Specialty Instructor or above

Choose the certifying agency for your highest level of certification:

Not Certified PADI NAUI SSI IANTD TDI DRI PSDA Other

Choose the selection below of CPR/First aid training that best describes your training level:

Not Certified Basic CPR First Aid First Responder Health Care Provider Level EMT-Basic Nurse EMT-Paramedic Wilderness EMT Trained

Are you a Fire Fighter, Law Enforcement, EMT-P, or other DES employee.

None Fire Fighter Law Enforcement EMT DES Employee

What would you like SWORD to do, select any of the following options that apply:

Send me general information via email
Send me general information via regular mail    
Give me a call back via contact number          
Send me membership application materials      
Add me to a newsletter mailing                  
Add my e-mail to your list of SWORD supporters  
Send me information about non-profit donations