Membership Application

"*" indicates required fields

Membership Selection Type*

Student Pass
Select if you are:
1. Not currently a certified diver taking an Open Water Class
2. A certified diver taking a continuing education training class beyond open water.
* The student pass is only valid for the duration of your course, and your instructor must be with you on the property.

Annual Membership
• Choose the appropriate membership type whether you are renewing or joining for the first time.
• The annual membership expires on December 31 regardless of when you join.
• Only certified divers can join as members. See complete rules for joining.
• Any child over the age of 18 is not eligible on a parent or guardians’ membership and they must obtain their own membership.

Annual Membership*

Choose the proper membership or upgrade

Student Pass*

Choose the proper student pass

New Member (Non Instructor)

Price:

Renewal (Non Instructor)

In order to use this renewal form before January 1st, you must hold a current membership. Otherwise you will need to use the New Member form.

Price:

New Member (Instructor)

Price:

Renewal (Instructor)

In order to use this renewal form before January 1st, you must hold a current membership. Otherwise you will need to use the New Member form.

Price:

Public Safety Instructor*

Do you teach Public Safety to a government team such as Fire Department, Police Department or government dive team?

Continuing Education Training Pass

Price:

Please Note: This membership is only valid for Non-Member students looking to take Continuing Education Courses without buying a full membership. No card and key will be issued for this membership type.

Openwater Training Pass

Price:

Please Note: This membership is only valid for students looking to take their Open Water Certification. No card and key will be issued for this membership type.

Under 18 Openwater Training Pass

Price:

Please Note: This membership is valid for students under the age of 18 looking to take their Open Water or Specialty Certifications. No card and key will be issued for this membership type.

Upgrade Student Pass to Regular Member

Price:

Please Note: This membership is for students that have earned their Open Water Certification within the past year and would like to become full PDRA members. Once registered a card and key will be issued.

Name of Instructor and/or Dive Shop*

Note: If you are applying for a Diving Student Training Pass, you must list the name of your instructor and/or the dive shop through which you are taking your classes.

New Member Quarry Selection*

Please select which quarry you will be diving at most often

Upgrade Member Quarry Selection*

Please select which quarry you will be diving at most often

Instructor Committe Member American Quarry*

Please select which Instructor Committee Member you interviewed with.

Instructor Committe Member JMR Quarry*

Please select which Instructor Committee Member you interviewed with

Instructor Committe Member Lake Norman Quarry*

Please select which Instructor Committee Member you interviewed with

New Instructor Proof of Insurance*

Note: PDRA Rules requires that all members who are applying as instructors must complete all information found in the "New Instructor Information Packet". PDRA-approved instructors must provide proof of insurance and show that PDRA is listed as an "additional insured" before being issued a card and key. Please upload a PDF copy of your proof of insurance here. If you are listed on the policy of a Dive shop, you must provide a copy of the proof of insurance where you are listed as being insured. If you are applying as a new instructor you will be contacted by a PDRA representative to start the interview process.

Drop files here or

Accepted file types: pdf, jpg, png, jpeg, Max. file size: 300 MB.

Member Certification Card*

Note: Whether you are a New Member, a Renewing Member (including Family Members), or taking Continuing Education Course you must upload an image of your Diving Certification Card. You can either take a photo of your physical card or take a screenshot of your Digital Card and upload it here.

Drop files here or

Accepted file types: pdf, jpg, png, jpeg, Max. file size: 300 MB.

Instructor Proof of Insurance Instuctor Renewal*

Note: PDRA Rules requires that all members who are renewing as instructors must resubmit their proof on insurance each year. PDRA-approved instructors must provide proof of insurance and show that PDRA is listed as an "additional insured" before being issued a card and key. Please upload a PDF copy of your proof of insurance here. If you are listed on the policy of a Dive shop, you must provide a copy of the proof of insurance where you are listed as being insured.

Drop files here or

Accepted file types: pdf, jpg, png, jpeg, Max. file size: 300 MB.

New Instructor Information Packet*

Please upload a scanned and signed copy of your New Instructor Information Packet. Note: Incomplete packets will be rejected and not approved.

Drop files here or

Accepted file types: pdf, jpg, png, jpeg, Max. file size: 300 MB.

Specialty Course*

Type which Course to be taught and the Agency

Instructor Certification "C" Card*

Please upload a scanned copy of your Instructor Certification "C" Card.

Drop files here or

Accepted file types: pdf, jpg, png, jpeg, Max. file size: 300 MB.

Applicant Full Name*

First Last

Current Member Name*

First Last

Key/Card Number

If you are renewing your membership or adding a family member, please put your most recent Key/Card # number here.

Applicant Date of Birth*

Is the Applicant under the age of 18?*

Applicant Address*

Street Address City State ZIP Code

Applicant Phone*

Applicant Email*

Estimated Date of Instruction*

Family Membership

• Only a legal spouse or children under the age of 18 living in the same household may join as family members.
• Non-diving members of a family are included in this membership at no additional cost.
• ALL DIVING members of the family are required to join as family members and EACH individual diving family member must sign this membership application and the statement of understanding.

Please note how many family members (IN ADDITION TO MEMBER NAMED ABOVE) need membership ($20/family member)*

Name (Family Member #1)*

First Last

Email (Must be different from main member)*

Age (Family Member #1)*

Relationship (Family Member #1)*

Diver (Family Member #1)*

Yes

Diver 1 Membership

Price:

Non-Diver 1 Membership

Price:

Name (Family Member #2)*

First Last

Email (Must be different from main member)*

Age (Family Member #2)*

Relationship (Family Member #2)*

Diver (Family Member #2)*

Yes

Diver 2 Membership

Price:

Non-Diver 2 Membership

Price:

Name (Family Member #3)*

First Last

Email (Must be different from main member)*

Age (Family Member #3)*

Relationship (Family Member #3)*

Diver (Family Member #3)*

Yes

Diver 3 Membership

Price:

Non-Diver 3 Membership

Price:

Name (Family Member #4)*

First Last

Email (Must be different from main member)*

Age (Family Member #4)*

Relationship (Family Member #4)*

Diver (Family Member #4)*

Yes

Diver 4 Membership

Price:

Non-Diver 4 Membership

Price:

Name (Family Member #5)*

First Last

Email (Must be different from main member)*

Age (Family Member #5)*

Relationship (Family Member #5)*

Diver (Family Member #5)*

Yes

Diver 5 Membership

Price:

Non-Diver 5 Membership

Price:

Name (Family Member #6)*

First Last

Email (Must be different from main member)*

Age (Family Member #6)*

Relationship (Family Member #6)*

Diver (Family Member #6)*

Yes

Diver 6 Membership

Price:

Non-Diver 6 Membership

Price:

Name (Family Member #7)*

First Last

Email (Must be different from main member)*

Age (Family Member #7)*

Relationship (Family Member #7)*

Diver (Family Member #7)*

Yes

Diver 7 Membership

Price:

Non-Diver 7 Membership

Price:

Name (Family Member #8)*

First Last

Email (Must be different from main member)*

Age (Family Member #8)*

Relationship (Family Member #8)*

Diver (Family Member #8)*

Yes

Diver 8 Membership

Price:

Non-Diver 8 Membership

Price:

Member Application Terms

Statement of Understanding and Liability Waiver*

By applying for membership and using PDRA property, I affirm my understanding and acceptance of the Statement of Understanding and Liability Waiver.

PDRA Rules and Regulations, the By-Laws and the Code of Ethics*

By joining, I confirm that I have read, understood, and agree to comply with all PDRA Rules and Regulations, the By-Laws, and the Code of Ethics

Waiver*

I, on behalf of myself and my legal representatives (heirs, executors, administrators, etc.), permanently waive and release all current and future claims for injury or damages against the Piedmont Diving and Rescue Association, Inc. (PDRA) and its affiliates.

Online Video Meeting*

I, agree to participate in an online video meeting regarding proper gear cleaning protocols prior to my 2026 card and key being issued. An email invitation will be sent to the email provided on the application.

Student Pass Terms

Statement of Understanding and Liability Waiver*

By applying for student pass and using PDRA property, I affirm my understanding and acceptance of the Statement of Understanding and Liability Waiver.

PDRA Rules and Regulations, the By-Laws and the Code of Ethics*

By joining, I confirm that I have read, understood, and agree to comply with all PDRA Rules and Regulations, the By-Laws, and the Code of Ethics

Waiver*

In witness where of I hereto set my hand and seal this day of (Today's Date)*

IN THE MATTER OF THE PIEDMONT DIVING AND RESCUE ASSOCIATION, INC. AND (LIST FULL NAME OF APPLICANT)*

First Last

Applicant Signature*

Signature of Parent/Guardian if under 18/Signature Family Member*

Signature Family Member*

Total

Date