ITDA Group International - Dive Centre Registration Form See also dive centre membership page with lists of pricing details for ITDA Group International Centres, ITDA Asia S.E. and ITDA Europe Ltd. May have different price structures please send an email to the regional office or ITDA Group HQ.

Dive Centre Applicaion / Registration Please complete this form in full, and we will email you with a membership number and details of membership benefits. Details of Personal Contact If you are the person completing this ITDA Group International / IHMP Dive centre registration please enter your details here. (Registrations will be valid from the date on this form for 2010/11 for ITDA Group Services / ITDA Group Technical or ITDA/SDA Sports Diving and IHMP Medical Training. You will be our primary contact. A secondary contact may be added at the bottom of this form. Family Name* First Names* Date of Birth* Your Title* Your Email Address* Your ITDA Group International Certifying Office Your ITDA Group Instructor No/Ref and Name. Your ITDA Group Instructor Email address Your Training Centre / Facility Name* Please check ITDA Group Training and Certification you want to offer? Sports Diving Rescue Diving Professional Rescue IHMP Medical Training Advanced Diving Technical Diving Specialist Diving Leadership Levels Higher Education (cert,dip,degree) Occupational / Commercial Diving Are you Interested in ITDA Group Offers? Training Branded Products Professional Membership Please attach a Jpeg photo, 300dpi. of your Dive Centre* Your Email Address (again Please!) this helps prevent spamming.* Your Business Web Address (URL) Dive Centre Contact Details Please give the full postal address Address* Address Town / City* State / Region / County * Post Code / Zip * Country Contact Language preferred (default is English)* Please add secondary contact details here. Please check which other agencies your centre offer(s), (This will NOT affect your application), Thank You. PADI NAUI CMAS SSI IANTD TDI/SDI Other Would you like to take advantage of Web advertising on ITDA Group Sites? Yes No Not Sure