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Please fill this out to get on the SSA4Vets data base. 

Welcome to SSA4VETS and U.S. Dive Veterans list.  We look forward to having you join us exploring the underwater world. Please join our database and stay informed as a DiveVeteran!

Thank You!

First Dive Veterans Name

First Name*

Last Name*

Phone*
First Dive Veterans Date of Birth*
First Dive Veterans Signature*
Second Dive Veterans Name

First Name*

Last Name*
Second Dive Veterans Date of Birth*
Third Dive Veterans Name

First Name*

Last Name*
Third Dive Veterans Date of Birth*
Fourth Dive Veterans Name

First Name*

Last Name*
Fourth Dive Veterans Date of Birth*
Fifth Dive Veterans Name

First Name*

Last Name*
Fifth Dive Veterans Date of Birth*
Sixth Dive Veterans Name

First Name*

Last Name*
Sixth Dive Veterans Date of Birth*
Seventh Dive Veterans Name

First Name*

Last Name*
Seventh Dive Veterans Date of Birth*
Eighth Dive Veterans Name

First Name*

Last Name*
Eighth Dive Veterans Date of Birth*
Ninth Dive Veterans Name

First Name*

Last Name*
Ninth Dive Veterans Date of Birth*
Tenth Dive Veterans Name

First Name*

Last Name*
Tenth Dive Veterans Date of Birth*
Dive Veterans Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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