| PASSPORT
INFORMATION
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| Full Name in
Passport: |
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Preferred Name:
(how you like to be addressed) |
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Passport
Number:
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Nationality:
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Issuing
Authority:
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Male:
Female:
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Issue
Date:
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Expiry
Date:
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Date
of Birth:
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| DIVING
INFORMATION
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Total Dives:
Last Dive:
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Diving
Since:
Nitrox Certified:
Use Nitrox:
(32% oxygen. Costs extra) |
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FLIGHT
INFORMATION
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HOTEL
INFORMATION
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* Airport
or Hotel Transfers are included on Cruise Departure and Disembarkation
Days only,
either Hotel or Airport. NOT both. |
| OTHER
INFORMATION |
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Are You An Underwater
Photographer?
Digital:
Video:
Film:
|
Dive Injury Insurance: (compulsory,
MUST be covered before boarding)
If Other:
Policy No:
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Cancellation
Insurance: (not compulsory
but STRONGLY RECOMMENDED)
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Dietary
Limitations: (food
allergies, vegetarian, no red meat, no seafood, etc. NOT food
preferences)
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Medical Conditions We Should Be Aware Of: (bad
back, need assistance with tanks, etc)
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Emergency
Contact: (one person to contact
and how, plus their relationship to you)
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Additional Information, Questions, Queries,
Requests:
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| Click for a Printable
Version of this form which can be returned
by fax or email. |
| If you have any problems
with this form contact us at:
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