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<title>DAN Shop</title>
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</head>
<body>
<header class="header header-bg">
<div class="menu-head">
<div class="container">
<nav class="navbar navbar-expand-lg">
<div class="container-fluid">
<a class="navbar-brand" href="#"><img src="images/logo.png" alt=""></a>
<button class="navbar-toggler" type="button" data-bs-toggle="collapse" data-bs-target="#navbarSupportedContent" aria-controls="navbarSupportedContent" aria-expanded="false" aria-label="Toggle navigation"><span class="navbar-toggler-icon"></span></button>
<div class="collapse navbar-collapse" id="navbarSupportedContent">
<ul class="navbar-nav ms-xxl-auto">
<li class="li-arrow"><a href="#">COVID-19</a>
<ul class="sub-menu">
<li><a href="#">Return To Diving Safely</a></li>
</ul>
</li>
<li class="li-arrow"><a href="#">About</a>
<ul class="sub-menu">
<li><a href="#">Our Team</a></li>
<li><a href="#">International DAN</a></li>
</ul>
</li>
<li class="li-arrow"><a href="#">Dive Cover </a>
<ul class="sub-menu">
<li><a href="#">Annual</a></li>
<li><a href="#">Annual Freediver</a></li>
<li><a href="#">Temporary</a></li>
<li><a href="#">Student</a></li>
<li><a href="#">Commercial</a></li>
<li><a href="#">Cancellation Request</a></li>
</ul>
</li>
<li class="li-arrow"><a href="#">Services </a>
<ul class="sub-menu">
<li><a href="#">Alert Diver</a></li>
<li><a href="#">Annual Diving Report</a></li>
<li><a href="#">Chamber Safety</a></li>
<li><a href="#">DAN Resources</a></li>
<li><a href="#">Dive Medical Forms</a></li>
<li><a href="#">Education</a></li>
<li><a href="#">Infographics</a></li>
<li><a href="#">Legal Network</a></li>
<li><a href="#">Medicine</a></li>
<li><a href="#">Partner Programs</a></li>
<li><a href="#">Research</a></li>
<li><a href="#">Report An Incident</a></li>
<li><a href="#">Technical Diving</a></li>
<li><a href="#">Test Station Resources</a></li>
<li><a href="#">Travel Notification</a></li>
<li><a href="#">Travel Statement</a></li>
<li><a href="#">Webinars</a></li>
</ul>
</li>
<li><a href="#">DAN Shop</a></li>
<li><a href="#">Blog</a></li>
<li class="li-arrow"><a href="#">Contact</a>
<ul class="sub-menu">
<li><a href="#">Dive Business Listing</a></li>
<li><a href="#">Find A DIve Doctor</a></li>
<li><a href="#">Find A DAN Instructor</a></li>
</ul>
</li>
<li><a href="#">JOIN - RENEW</a></li>
</ul>
</div>
</div>
</nav>
</div><!--/ menu-head -->
</div><!--/ container -->
</header>
<section class="form-wrap annual-application">
<div class="container">
<div class="row">
<div class="col-sm-12">
<div class="form-grid">
<div class="title">
<h2>Application Form</h2>
<p>Your application will be processed within 24 hours</p>
</div><!--/ title -->
<form>
<div class="form-steps form-group col-sm-12" id="step_1">
<div class="row">
<div class="form-group col-sm-12">
<div class="step-no">Step 1 of 6</div>
<h3>PERSONAL DETAILS</h3>
<p class="annual-p text-center">Please complete required fields</p>
<div class="form-bar">
<div class="form-clearbar"></div>
<div class="form-fillbar"></div>
</div><!--/ form-bar -->
</div>
<div class="form-group col-sm-4">
<label>Title</label>
<input class="form-control" placeholder="Mr" value="">
</div>
<div class="form-group col-sm-4">
<label>First name</label>
<input class="form-control" placeholder="john" value="">
</div>
<div class="form-group col-sm-4">
<label>Last name</label>
<input class="form-control" placeholder="Doe" value="">
</div>
<div class="form-group col-sm-6">
<label>Date of Birth</label>
<input class="form-control" placeholder="10-06-1990" value="">
</div>
<div class="form-group col-sm-6">
<label>Identity / Passport Number</label>
<input class="form-control" placeholder="000000-0000-000" type="phone" value="">
</div>
<div class="form-group col-sm-12">
<h4 class="mrb-0"><b>Address</b></h4>
</div>
<div class="form-group col-sm-6">
<label>Street</label>
<input class="form-control" placeholder="Oxford" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>City</label>
<input class="form-control" placeholder="London" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>State / Province</label>
<input class="form-control" placeholder="Greater London" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Postal / Zip code</label>
<input class="form-control" placeholder="E1 6AN" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Home Phone</label>
<input class="form-control" placeholder="+27-00-000-0000" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Work Phone</label>
<input class="form-control" placeholder="+27-00-000-0000" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Mobile Phone</label>
<input class="form-control" placeholder="+27-00-000-0000" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Email address </label>
<input class="form-control" placeholder="example@domain.com" type="text" value="">
</div>
<div class="form-group col-sm-12">
<h4 class="mrb-0"><b>Residency Details</b></h4>
</div>
<div class="form-group col-sm-12">
<label>Country of Residence</label>
<input class="form-control" placeholder="Where are you living or working at present" type="text" value="">
</div>
<div class="form-group col-sm-12 steps-btn">
<a href="#" class="btn next-btn" data-id="1">Next</a>
</div>
</div><!--/ row -->
</div><!--/ form-steps -->
<div class="form-steps form-group col-sm-12" id="step_2">
<div class="row">
<div class="form-group col-sm-12">
<div class="step-no">Step 2 of 6</div>
<h3>Diving Details</h3>
<p class="annual-p text-center">Please complete required fields</p>
<div class="form-bar">
<div class="form-clearbar"></div>
<div class="form-fillbar"></div>
</div><!--/ form-bar -->
</div>
<div class="form-group col-sm-12">
<h4 class="mrb-0"><b>Diving Qualification</b></h4>
</div>
<div class="form-group col-sm-6">
<label>Diving Qualification</label>
<input class="form-control" placeholder="Highest Qualification" value="">
</div>
<div class="form-group col-sm-6">
<label>Dive Agency</label>
<input class="form-control" placeholder="PADI - NAUI - RAID - SSI - IANTD" value="">
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Are you working as a Divemaster or Instructor?</label>
<div class="input-inner row">
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12">
<label class="label mrb-0">Type of Diver</label>
<p class="annual-p">Please complete required fields</p>
<div class="checkbox-custom">
<label class="checkbox">Scuba Diver
<input type="checkbox" name="Scuba" value="Bike">
<span class="checkmark"></span>
</label>
<label class="checkbox">Technical Diver
<input type="checkbox" name="Technical" value="Technical">
<span class="checkmark"></span>
</label>
<label class="checkbox">Freediver
<input type="checkbox" name="Freediver" value="Freediver">
<span class="checkmark"></span>
</label>
<label class="checkbox">Spearfisherman
<input type="checkbox" name="Spearfisherman" value="Spearfisherman">
<span class="checkmark"></span>
</label>
<label class="checkbox">Snorkeler
<input type="checkbox" name="Snorkeler" value="Snorkeler">
<span class="checkmark"></span>
</label>
</div>
</div>
<div class="form-group col-sm-12">
<h4 class="mrb-0"><b>Referral Details</b></h4>
</div>
<div class="form-group col-sm-6">
<label>Referral Dive Centre</label>
<input class="form-control" placeholder="Dive Centre or Dive Resort" value="">
</div>
<div class="form-group col-sm-6">
<label>Referral Dive Instructor</label>
<input class="form-control" placeholder="Name of Dive Instructor" value="">
</div>
<div class="form-group col-sm-12 steps-btn">
<div class="row">
<div class="col-sm-12"><a href="#" class="btn btn-lightgray back-btn" data-id="2">Back</a> <a href="#" class="btn next-btn" data-id="2">Next</a></div>
</div>
</div>
</div><!--/ row -->
</div><!--/ form-steps -->
<div class="form-steps form-group col-sm-12" id="step_3">
<div class="row">
<div class="form-group col-sm-12">
<div class="step-no">Step 3 of 6</div>
<h3>Medical Insurance Details</h3>
<p class="annual-p text-center">Please complete required fields</p>
<div class="form-bar">
<div class="form-clearbar"></div>
<div class="form-fillbar"></div>
</div><!--/ form-bar -->
</div>
<div class="form-group col-sm-6">
<label>Medical Aid / Healthcare Insurance Name</label>
<input class="form-control" placeholder="Discovery Health Medical Scheme" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Medical Aid / Healthcare Insurance Number</label>
<input class="form-control" placeholder="Policy Number" type="text" value="">
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Are you using any medication regularly?</label>
<div class="input-inner row">
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Do you suffer from any chronic illness?</label>
<div class="input-inner row">
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12 steps-btn">
<div class="row">
<div class="col-sm-12"><a href="#" class="btn btn-lightgray back-btn" data-id="3">Back</a> <a href="#" class="btn next-btn" data-id="3">Next</a></div>
</div>
</div>
</div><!--/ row -->
</div><!--/ form-steps -->
<div class="form-steps form-group col-sm-12" id="step_4">
<div class="row">
<div class="form-group col-sm-12">
<div class="step-no">Step 4 of 6</div>
<h3>Family Members</h3>
<p class="annual-p text-center">If you have any diving or non-diving familiy members please list them below. Diving family members will carry a charge and non-diving family members have no charge.</p>
<div class="form-bar">
<div class="form-clearbar"></div>
<div class="form-fillbar"></div>
</div><!--/ form-bar -->
</div>
<div class="form-group col-sm-12">
<h4 class="mrb-0"><b>Family Member 1</b></h4>
</div>
<div class="form-group col-sm-4">
<label>1. Family Member Title</label>
<input class="form-control" placeholder="Mr." type="text" value="">
</div>
<div class="form-group col-sm-4">
<label>1. First name</label>
<input class="form-control" placeholder="john" type="text" value="">
</div>
<div class="form-group col-sm-4">
<label>1. Last name</label>
<input class="form-control" placeholder="Doe" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Date of Birth</label>
<input class="form-control" placeholder="10-06-1990" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Identity / Passport Number</label>
<input class="form-control" placeholder="000000-0000-000" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>1. Email</label>
<input class="form-control" placeholder="example@domain.com" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Mobile Phone</label>
<input class="form-control" placeholder="+27-00-000-0000" type="text" value="">
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Diver</label>
<div class="input-inner row">
<div class="col-sm-12 mrb-12 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12">
<label class="label">Type of Diver</label>
<div class="checkbox-custom">
<label class="checkbox">Scuba Diver
<input type="checkbox" name="Scuba" value="Bike">
<span class="checkmark"></span>
</label>
<label class="checkbox">Technical Diver
<input type="checkbox" name="Technical" value="Technical">
<span class="checkmark"></span>
</label>
<label class="checkbox">Freediver
<input type="checkbox" name="Freediver" value="Freediver">
<span class="checkmark"></span>
</label>
<label class="checkbox">Spearfisherman
<input type="checkbox" name="Spearfisherman" value="Spearfisherman">
<span class="checkmark"></span>
</label>
<label class="checkbox">Snorkeler
<input type="checkbox" name="Snorkeler" value="Snorkeler">
<span class="checkmark"></span>
</label>
</div>
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Is your family member working as a Divemaster or Instructor?</label>
<div class="input-inner row">
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Are you using any medication regularly?</label>
<div class="input-inner row">
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12 mrb-30">
<div class="input-group">
<label class="label">Do you suffer from any chronic illness? </label>
<div class="input-inner row">
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12">
<h4 class="mrb-0"><b>Family Member 2</b></h4>
</div>
<div class="form-group col-sm-4">
<label>2. Family Member Title</label>
<input class="form-control" placeholder="Mr." type="text" value="">
</div>
<div class="form-group col-sm-4">
<label>2. First name</label>
<input class="form-control" placeholder="john" type="text" value="">
</div>
<div class="form-group col-sm-4">
<label>2. Last name</label>
<input class="form-control" placeholder="Doe" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Date of Birth</label>
<input class="form-control" placeholder="10-06-1990" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Identity / Passport Number</label>
<input class="form-control" placeholder="000000-0000-000" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>2. Email</label>
<input class="form-control" placeholder="example@domain.com" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Mobile Phone</label>
<input class="form-control" placeholder="+27-00-000-0000" type="text" value="">
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Diver</label>
<div class="input-inner row">
<div class="col-sm-12 mrb-12 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12">
<label class="label">Type of Diver</label>
<div class="checkbox-custom">
<label class="checkbox">Scuba Diver
<input type="checkbox" name="Scuba" value="Bike">
<span class="checkmark"></span>
</label>
<label class="checkbox">Technical Diver
<input type="checkbox" name="Technical" value="Technical">
<span class="checkmark"></span>
</label>
<label class="checkbox">Freediver
<input type="checkbox" name="Freediver" value="Freediver">
<span class="checkmark"></span>
</label>
<label class="checkbox">Spearfisherman
<input type="checkbox" name="Spearfisherman" value="Spearfisherman">
<span class="checkmark"></span>
</label>
<label class="checkbox">Snorkeler
<input type="checkbox" name="Snorkeler" value="Snorkeler">
<span class="checkmark"></span>
</label>
</div>
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Is your family member working as a Divemaster or Instructor?</label>
<div class="input-inner row">
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Are you using any medication regularly?</label>
<div class="input-inner row">
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12 mrb-30">
<div class="input-group">
<label class="label">Do you suffer from any chronic illness? </label>
<div class="input-inner row">
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12">
<h4 class="mrb-0"><b>Family Member 3</b></h4>
</div>
<div class="form-group col-sm-4">
<label>3. Family Member Title</label>
<input class="form-control" placeholder="Mr." type="text" value="">
</div>
<div class="form-group col-sm-4">
<label>3. First name</label>
<input class="form-control" placeholder="john" type="text" value="">
</div>
<div class="form-group col-sm-4">
<label>3. Last name</label>
<input class="form-control" placeholder="Doe" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Date of Birth</label>
<input class="form-control" placeholder="10-06-1990" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Identity / Passport Number</label>
<input class="form-control" placeholder="000000-0000-000" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>3. Email</label>
<input class="form-control" placeholder="example@domain.com" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Mobile Phone</label>
<input class="form-control" placeholder="+27-00-000-0000" type="text" value="">
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Diver</label>
<div class="input-inner row">
<div class="col-sm-12 mrb-12 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12">
<label class="label">Type of Diver</label>
<div class="checkbox-custom">
<label class="checkbox">Scuba Diver
<input type="checkbox" name="Scuba" value="Bike">
<span class="checkmark"></span>
</label>
<label class="checkbox">Technical Diver
<input type="checkbox" name="Technical" value="Technical">
<span class="checkmark"></span>
</label>
<label class="checkbox">Freediver
<input type="checkbox" name="Freediver" value="Freediver">
<span class="checkmark"></span>
</label>
<label class="checkbox">Spearfisherman
<input type="checkbox" name="Spearfisherman" value="Spearfisherman">
<span class="checkmark"></span>
</label>
<label class="checkbox">Snorkeler
<input type="checkbox" name="Snorkeler" value="Snorkeler">
<span class="checkmark"></span>
</label>
</div>
</div>
<div class="form-group col-sm-12">
<h4 class="mrb-0"><b>Family Member 4</b></h4>
</div>
<div class="form-group col-sm-4">
<label>4. Family Member Title</label>
<input class="form-control" placeholder="Mr." type="text" value="">
</div>
<div class="form-group col-sm-4">
<label>4. First name</label>
<input class="form-control" placeholder="john" type="text" value="">
</div>
<div class="form-group col-sm-4">
<label>4. Last name</label>
<input class="form-control" placeholder="Doe" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Date of Birth</label>
<input class="form-control" placeholder="10-06-1990" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Identity / Passport Number</label>
<input class="form-control" placeholder="000000-0000-000" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>4. Email</label>
<input class="form-control" placeholder="example@domain.com" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Mobile Phone</label>
<input class="form-control" placeholder="+27-00-000-0000" type="text" value="">
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Diver</label>
<div class="input-inner row">
<div class="col-sm-12 mrb-12 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12">
<label class="label">Type of Diver</label>
<div class="checkbox-custom">
<label class="checkbox">Scuba Diver
<input type="checkbox" name="Scuba" value="Bike">
<span class="checkmark"></span>
</label>
<label class="checkbox">Technical Diver
<input type="checkbox" name="Technical" value="Technical">
<span class="checkmark"></span>
</label>
<label class="checkbox">Freediver
<input type="checkbox" name="Freediver" value="Freediver">
<span class="checkmark"></span>
</label>
<label class="checkbox">Spearfisherman
<input type="checkbox" name="Spearfisherman" value="Spearfisherman">
<span class="checkmark"></span>
</label>
<label class="checkbox">Snorkeler
<input type="checkbox" name="Snorkeler" value="Snorkeler">
<span class="checkmark"></span>
</label>
</div>
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Is your family member working as a Divemaster or Instructor?</label>
<div class="input-inner row">
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Are you using any medication regularly?</label>
<div class="input-inner row">
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12 mrb-30">
<div class="input-group">
<label class="label">Do you suffer from any chronic illness? </label>
<div class="input-inner row">
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Yes</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> No</label></div>
</div>
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<div class="form-group col-sm-12">
<div class="step-no">Step 5 of 6</div>
<h3>Next of Kin Details</h3>
<p class="annual-p text-center">Please complete required fields</p>
<div class="form-bar">
<div class="form-clearbar"></div>
<div class="form-fillbar"></div>
</div><!--/ form-bar -->
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<div class="form-group col-sm-4">
<label>N.O.K. Title</label>
<input class="form-control" placeholder="Mr" type="text" value="">
</div>
<div class="form-group col-sm-4">
<label>First name</label>
<input class="form-control" placeholder="John" type="text" value="">
</div>
<div class="form-group col-sm-4">
<label>Last name</label>
<input class="form-control" placeholder="Doe" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Date of Birth</label>
<input class="form-control" placeholder="10-06-1990" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Identity / Passport Number</label>
<input class="form-control" placeholder="000000-0000-000" type="text" value="">
</div>
<div class="form-group col-sm-12">
<h4 class="mrb-0"><b>Address</b></h4>
</div>
<div class="form-group col-sm-6">
<label>Street</label>
<input class="form-control" placeholder="Oxford" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>City</label>
<input class="form-control" placeholder="London" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>State / Province</label>
<input class="form-control" placeholder="Greater Londoon" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Postal / Zip code</label>
<input class="form-control" placeholder="E1 6AN" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Home Phone</label>
<input class="form-control" placeholder="+27-00-000-0000" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Work Phone</label>
<input class="form-control" placeholder="+27-00-000-0000" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Mobile Phone</label>
<input class="form-control" placeholder="+27-00-000-0000" type="text" value="">
</div>
<div class="form-group col-sm-6">
<label>Email</label>
<input class="form-control" placeholder="example@domain.com" type="text" value="">
</div>
<div class="form-group col-sm-12">
<h4 class="mrb-0"><b>Relationship</b></h4>
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Relationship to main member</label>
<div class="input-inner row">
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Spouse</label></div>
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Parent</label></div>
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Child</label></div>
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Partner</label></div>
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Friend</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> Brother/Sisiter</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12">
<label><i>Please note it remains your responsibility to notify DAN if your Next of Kin details change</i></label>
</div>
<div class="form-group col-sm-12 steps-btn">
<div class="row">
<div class="col-sm-12"><a href="#" class="btn btn-lightgray back-btn" data-id="5">Back</a> <a href="#" class="btn next-btn" data-id="5">Next</a></div>
</div>
</div>
</div><!--/ row -->
</div><!--/ form-steps -->
<div class="form-steps form-group col-sm-12" id="step_6">
<div class="row">
<div class="form-group col-sm-12">
<div class="step-no">Step 6 of 6</div>
<h3>Choose your Package</h3>
<p class="annual-p text-center">Please complete required fields</p>
<div class="form-bar">
<div class="form-clearbar"></div>
<div class="form-fillbar"></div>
</div><!--/ form-bar -->
</div>
<div class="form-group col-sm-12">
<label>Membership Start Date</label>
<input class="form-control" placeholder="10-06-1990" type="text" value="">
</div>
<div class="form-group col-sm-12">
<label>Select Membership Package</label>
<select class="form-control mrb-10"><option value="">Select Package</option><option value="Standard Membership">Standard Membership</option><option value="Plus Membership">Plus Membership</option><option value="Master Dive Pro Membership">Master Dive Pro Membership</option><option value="Master Freediver Pro Membership">Master Freediver Pro Membership</option><option value="Master Tech Membership">Master Tech Membership</option></select>
<p class="annual-p mrb-0">All the packages listed are annual membership packages</p>
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">How many diving family members do you want to add?</label>
<div class="input-inner row">
<div class="col-sm-12 input-radio mrb-10"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span>None</label></div>
<div class="col-sm-12 input-radio mrb-10"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span>1 diving family members</label></div>
<div class="col-sm-12 input-radio mrb-10"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span>2 diving family members</label></div>
<div class="col-sm-12 input-radio mrb-10"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span>3 diving family members</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span>4 diving family members</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-6">
<label>Select Membership Package for Diving Family 1</label>
<select class="form-control mrb-10"><option value="" disabled="">Select Package</option><option value="Standard Membership">Standard Membership</option><option value="Plus Membership">Plus Membership</option><option value="Master Dive Pro Membership">Master Dive Pro Membership</option><option value="Master Freediver Pro Membership">Master Freediver Pro Membership</option><option value="Master Tech Membership">Master Tech Membership</option></select>
<p class="annual-p mrb-0">All the packages listed are annual membership packages</p>
</div>
<div class="form-group col-sm-6">
<label>Select Membership Package for Diving Family 2</label>
<select class="form-control mrb-10"><option value="" disabled="">Select Package</option><option value="Standard Membership">Standard Membership</option><option value="Plus Membership">Plus Membership</option><option value="Master Dive Pro Membership">Master Dive Pro Membership</option><option value="Master Freediver Pro Membership">Master Freediver Pro Membership</option><option value="Master Tech Membership">Master Tech Membership</option></select>
<p class="annual-p mrb-0">All the packages listed are annual membership packages</p>
</div>
<div class="form-group col-sm-6">
<label>Select Membership Package for Diving Family 3</label>
<select class="form-control mrb-10"><option value="" disabled="">Select Package</option><option value="Standard Membership">Standard Membership</option><option value="Plus Membership">Plus Membership</option><option value="Master Dive Pro Membership">Master Dive Pro Membership</option><option value="Master Freediver Pro Membership">Master Freediver Pro Membership</option><option value="Master Tech Membership">Master Tech Membership</option></select>
<p class="annual-p mrb-0">All the packages listed are annual membership packages</p>
</div>
<div class="form-group col-sm-6">
<label>Select Membership Package for Diving Family 4</label>
<select class="form-control mrb-10"><option value="" disabled="">Select Package</option><option value="Standard Membership">Standard Membership</option><option value="Plus Membership">Plus Membership</option><option value="Master Dive Pro Membership">Master Dive Pro Membership</option><option value="Master Freediver Pro Membership">Master Freediver Pro Membership</option><option value="Master Tech Membership">Master Tech Membership</option></select>
<p class="annual-p mrb-0">All the packages listed are annual membership packages</p>
</div>
<div class="form-group col-sm-12">
<div class="input-group">
<label class="label">Choose Your Payment Option </label>
<div class="input-inner row">
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Monthly via Debit Order</label></div>
<div class="col-sm-12 mrb-10 input-radio"><label class="radio-container mrb-r"><input type="radio" checked="checked" name="gender"><span class="checkmark"></span> Once Off via Bank Transfer</label></div>
<div class="col-sm-12 input-radio"><label class="radio-container"><input type="radio" name="gender"><span class="checkmark"></span> Once Off via Credit Card</label></div>
</div>
</div>
</div>
<div class="form-group col-sm-12">
<h4 class="mrb-30"><b>Membership Benefits & Costs</b></h4>
<p class="mrb-0"><a href="images/Annual-Guide-2022.pdf" rel="noopener noreferrer" target="_blank"> <strong>Click to Download the Annual Membership Benefits Guide</strong></a></p>
</div>
<div class="form-group col-sm-6">
<label>Standard Membership</label>
<ul class="mrb-0">
<li>R159 per month or R1900 annually per diver</li>
<li>R500 000 Dive Cover</li>
<li>Evacuation Assistance</li>
<li>International Dive Cover</li>
<li>R500 000 Personal Liability</li>
<li>Add Additional Diving Members</li>
<li>SCUBA & Freediving Depth Limit 40 meters</li>
<li>Includes Cover for Freedivers</li>
<li>Includes Cover for Spear Fisherman</li>
</ul>
</div>
<div class="form-group col-sm-6">
<label>Plus Membership</label>
<ul class="mrb-0">
<li>R196 per month or R2350 annually per diver</li>
<li>R700 000 Dive Cover</li>
<li>Evacuation Assistance</li>
<li>International Dive Cover</li>
<li>R1 000 000 Personal Liability</li>
<li>Add Additional Diving Members</li>
<li>SCUBA & Freediving Depth Limit 40 meters</li>
<li>International Non-Diving Cover</li>
<li>Includes Cover for Freedivers</li>
<li>Includes Cover for Spear Fisherman</li>
</ul>
</div>
<div class="form-group col-sm-6">
<label>Master Dive Pro/Master Freediver Pro Membership</label>
<ul class="mrb-0">
<li>R212 per month or R2540 annually per diver</li>
<li>R800 000 Dive Cover</li>
<li>Evacuation Assistance</li>
<li>International Dive Cover</li>
<li>R2 000 000 Personal Liability</li>
<li>Add Additional Diving Members</li>
<li>SCUBA & Freediving Depth Limit 40 meters</li>
<li>International Non-Diving Cover</li>
<li>Includes Cover for Freedivers</li>
<li>Includes Cover for Spear Fisherman</li>
<li>Suitable for instructors, active recreational divers & competitive freedivers.</li>
<li>Freedivers diving deeper that 40 meters need to submit a dive plan to the DAN Hotline team.</li>
</ul>
</div>
<div class="form-group col-sm-6">
<label>Master Tech Membership</label>
<ul class="mrb-0">
<li>R227 per month or R2735 annually per diver</li>
<li>R900 000 Dive Cover</li>
<li>Evacuation Assistance</li>
<li>International Dive Cover</li>
<li>R2 000 000 Personal Liability</li>
<li>Add Additional Diving Members</li>
<li>TECH Depth Limit 100 meters</li>
<li>International Non-Diving Cover</li>
<li>For TECH dive expeditions deeper that 100 meters you need to submit a dive plan to the Hotline team. To learn more use this <a href="technical-diving.html">link</a>. </li></ul>
</div>
<div class="form-group col-sm-12">
<div class="checkbox-custom">
<label class="checkbox">I’ve read and agree with the <a href="images/Annual-Guide-2022.pdf" rel="noopener noreferrer" target="_blank">Terms of the Annual Membership Benefits</a> and the <a href="privacy-policy.html" rel="noopener noreferrer" target="_blank"><span>DAN Privacy Policy</span></a>
<input type="checkbox" name="Scuba" value="Bike">
<span class="checkmark"></span>
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<h4>Divers Alert Network</h4>
<p>DAN is Divers Alert Network, the diving industry’s largest association dedicated to scuba diving safety. Serving scuba divers for 20 years, DAN provides emergency assistance, medical information resources, educational opportunities and more. Whether you are just learning how to scuba dive or are a veteran of the sport, DAN has a great deal to offer you.</p>
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<h4>Your Adventure! Your Safety!</h4>
<p>DAN has always been about the partnership between our organisation and the scuba divers who support it. DAN Members enjoy great benefits, including Travel Assistance, Alert Diver magazine, and access to industry-leading dive cover products. But the best benefit is being a part of and supporting the largest association of scuba divers dedicated to diving safety.</p>
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<h4>Dive Cover</h4>
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