Please print and complete this form and mail with your check for the appropriate membership amount to:

NCUPS
Attn: Membership
PO Box 1168
Alameda, CA 94501

Membership Type (circle one):

New Renewal Renew with Address Change

First Name: ___________________________________________

Last Name: ___________________________________________

Email address: ________________________________________

( ) I would like to receive NCUPS events information and other emailed communications (Please check box)

For family memberships:

Spouse’s name: ________________________________________

Child(ren)’s name(s): ____________________________________

2019 Membership levels:

Family membership — $55.00 for two or more members in the same household

Active membership — $45.00 for those who wish to participate in NCUPS activities

At-large membership — $30.00 for those unable to engage in local activities because of geographic location

Associate membership — $20.00 for those who do not dive, but wish to support the aims of NCUPS