New OBP Diver Registration/Wait List 2023-2024

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
• * What is your height and weight?

• *

  Veteran/Active Duty/Reservist/National Guard/Gold Star Family

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

  Disabled Veteran:

  • Yes
  • No
  • Pending
• * 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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• * 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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• * What is your T-Shirt size? --Choose-- XX Large Extra Large Large Medium Small
• * Shoe Size --Choose-- 6 7 8 9 10 11 12
• *

  What is your hood size?

  • XLL
  • XL
  • L
  • M

• *

  Are you a certified open water scuba diver?

  • Yes
  • No
• * Are you a dive professional and, if so, what is your certifying agency (PADI, SSI, SDI, etc.).
• * If you are a certified open water diver, list your certifications (open water, advanced open water, rescue, etc.), and certifying agencies.
• *

  What class are you interested in?

  • Open Water
  • Advanced
  • Specialty
• *

  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
• * How did you learn about Operation Blue Pride?
• Comments. Please provide any additional information that you feel may be important for OBP to know:
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