KIASU DIVERS ENTERPRISE (Co. Reg. 0001355599-W) Email: KiasuDivers@yahoo.com Website: http://www.KiasuDivers.com

No. 96 Jalan Othman, 1/14 Petaling Jaya, 46000 Selangor Fax: 03-77834490Kent (012-2072028), Clement (012-3255096), Paul (012-3822022), Andrew (016-2933776)

Membership Form

Preferred Name on Member Card

Name as in Identification Card

Places Of Interest

Identification Card #

Date of Birth (D/M/Y) Gender Male / Female

Contact # (M) (H) (O)

Emergency Contact #

Email Address

T-Shirt SizeName on T-Shirt

Self Rating

Mailing Address

Casual diver Never-Dive diver Crazy diver Once upon a time diver

Declaration & DisclaimerI, the above named with particulars as hereinbefore furnished, do hereby declare that I have the required physical fitness and ability to participate in the event and I further hereby confirm that I am participating at my sole risk and expense. I do further agree and declare that the inherent risks involved in participating in such an event have been fully explained to me and I have full knowledge of the inherent risks to my life as a result of my participation and I am participating in the event entirely on my own accord. I do hereby agree to absolve Kiasu Divers and the organisers from any liability whatsoever whether directly or indirectly as a result of any injury of any nature whatsoever to my physical well-being during the event including personal injury, death, and losses and any damage to my personal belongings and all legal proceedings or claims for any losses or compensation that may result from my participation in this event. I also agree to abide by all the rules and regulations, terms and conditions as set out by the club and I further agree to fully indemnify and cause to be fully indemnified Kiasu Divers and the organisers against all legal proceedings or claims for any losses or for any compensation for any reason whatsoever that may be brought against Kiasu Divers and the organisers in the event of my breach of the rules and regulations, terms and conditions as set out by the club in respect of the event.

Signature: ___________________ Date : ___________________

Dive Level Open Water Advance Dive Master Instructor

M / L / XL

Pulau Tioman

Pulau Kapas

Pulau Tenggol

Pulau Jarak

Phuket

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Pulau Redang

Pulau Perhentian

Pulau Lang Tengah

Pulau Layang Layang

Kosamoi

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Pulau Mintan Malu

Pulau Dayang

Pulau Sibu

Marine Park (TAR)

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Terms and Conditions• Membership registration fee of RM100 payable upon signup.• Monthly membership subscription fee of RM10 per month or RM100 per year*.• We accept payments by cash or cheque that made payable to Kiasu Divers Enterprise.• Confirmation of membership upon receipt of official stamped receipt.• Confirmed membership fees paid are non-refundable.• Member is not allowed to conduct any business offer or transaction on behalf of Kiasu Divers Enterprise.• All terms and conditions are subjected to change without prior notice.

* - Applicable only for the month of January, February and March.