July 31 2021 Boat Dive

Personal Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Address 1:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Phone:
• * Date of Birth

• Fee

  Type	Fee
  Event fee	$100.00

• *

  Veteran/Active Duty/Gold Star Family

  • Veteran
  • Active Duty
  • Reservist
  • Gold Star Family
  • Other
• *

  Disabled Veteran:

  • Yes
  • No
  • Pending
• * Please briefly describe your service (including any mobilizations and deployments such as, WWII, Korea, Vietnam, OIF/OEF/OND and mobilizations within the continental U.S.or its territories) and the associated time periods.
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• * Please provide any information about your disability that would help OBP be prepared to be responsive to your disability in your scuba training classes (such as adaptive gear, instructors, buddies and the like).
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• *

  Do you grant to OBP the right and permission to take photographs and videos during OBP events/activities and to use and publish the same in media, including the internet (and social media), without restriction? If not, kindly inform OBP so we can be sure that you do not appear in any such photographs and media.

  • Yes
  • No
• Comments. Please provide any additional information that you feel may be important for OBP to know:
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• * How did you learn about Operation Blue Pride?