DIVING WITH A PURPOSE CORAL RESTORATION PROGRAM

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1 DIVING WITH A PURPOSE CORAL RESTORATION PROGRAM (DWP-CRP) MAY July October 6-8, 2014 MOLASSES REEF, KEY LARGO FL PROGRAM CONTACT: KEN STEWART (615) The annual Diving With A Purpose (DWP) - Coral Restoration Program ram (CRP) is scheduled for three sessions, over three days, May 13-15, July 21-23, and October 6-8, The DWP-CRP is working in partnership with the Coral Restoration Foundation (CRF), located in Key Largo, Florida to conduct the training. The 3 day program will include 2 half days of classroom instruction with the CRF staff and 3 afternoon dives of maintaining and planting coral located in the National Marine Sanctuary. WHAT TO EXPECT Learn the environmental effects that currently threaten the worlds coral reefs Learn the techniques for establishing and maintaining a coral nursery Learn the techniques for harvesting and replanting Elkhorn and Staghorn coral A sense of accomplishment when helping to replenish endangered coral reefs ELIGIBILITY & WHAT YOU NEED PEAK BUOYANCY SKILLS Experience: 25 logged dives minimum. Dived within the ocean in the last year Confidence with long term dives (30 to 90 minutes) Own your own or rent dive gear ( including appropriate thermal wear for 70 degree water temps) EXPENSES Registration Fee - $ Includes: 2 days of classroom instruction, 3 days of diving. Registration consists of completing the application and returning it with the course fee. This will be based on a first- come, first-serve basis. The DWP-CRP fee is due in full with the completed DWP-CRP Registration form and a copy of your C-card. Once your application is submitted you are committed. Refunds are available ONLY when you have a TIMELY replacement. We are paying (in advance) for the boat.

2 DIVING WITH A PURPOSE CORAL RESTORATION PROGRAM May July 21 23, 2014 October 6-8, 2014 PROGRAM CONTACT: Ken Stewart (615) Jackson St., Nashville, TN Kenkye52@gmail.com The mission of Diving With a Purpose goes beyond underwater archeology and coral restoration education. We will always look for ways to challenge your interest and broaden your knowledge related to this vast aquatic environment. It offers unlimited challenges to the inquisitive mind. We want to make possible increased exposure, heightened awareness, and honed skills for various modes of recreational and specialty scuba diving... Safely. DWP-CRP 2014 REGISTRATION FORM NAME: DATE: ADDRESS: CITY: STATE: ZIP: HOME PH: DAY: CELL PH: (1): (2): T-SHIRT S - M - L - XL - XXL DIVING INFORMATION Dive Level & Number DIVE EXPERIENCE HOME SCUBA CLUB: Coral Restoration or Related Experience Dive Insurance # Number of Dives Logged: Deepest Dive: Date of Last Dive: NABS MEMBER NO.

3 Health Insurance Name of Primary Physician EMERGENCY CONTACT INFORMATION Phone: Insurance Acct # Tele No. Group Acct # 1 st Contact Name/Relationship: Day Phone Cell: Hm: Address City: State: Zip: 2 nd Contact Name/Relationship: Day Phone Cell: Hm: Address Coral Restoration Program Fee...$ DONATION (Youth DWP & Coral Restoration Project)....$ TOTAL....$ Method of Payment: Payment must be submitted with your application and a copy of your C-card. Without these enclosures we are unable to process your request to participate in DWP IX. ALL registration forms with enclosures (check or money order and C-card) should be mailed to: DWP * c/o Ken Stewart * 1309 Jackson St. * Nashville, TN Checks and Money Orders should be issued to DWP. ALL questions pertaining to Diving With a Purpose-Coral Restoration Program should be directed to Ken Stewart at (615) Voic is available. The cut-off date for consideration of your application is March 30, 2014 (US Postmark date).

4 Liability Waiver and Release: I, release Diving With a Purpose (DWP), its officers, trip leaders, committee members, or other members of the organization from any and all liabilities, claims, losses, expenses, injuries, or damages to persons or property which may arise out of, or be connected in any way with, any scheduled or unscheduled dive trip or activity it may offer. In exchange for being permitted to participate in any activity, I will not institute any action at law or in equity in consideration of any injury or other loss or damage sustained, or that may be sustained, by me as a consequence of my participation in an activity sponsored in full or in part by DWP. My participation in any activity offered by DWP is strictly voluntary. I understand that DWP and no other member of the organization shall in any way be responsible for the safety of any member, or be responsible for the services of accommodations being offered by other enterprises or persons on all trips and/or activities, scheduled or unscheduled by this organization. I agree to abide by the by-laws, rules and regulations of DWP. I will abide by safe diving practices and conduct my behavior in a responsible manner. This Waiver and Release form will be binding on me and on behalf of my heirs, agents, assigns and legal representatives. I further state that I have carefully read the foregoing Waiver and Release in its entirety. I sign this Waiver and Release knowingly and voluntarily with a full understanding of its content. Signature: Parent/Legal Guardian: Date:

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