SELECT DATE OF CLASS OR SIGN UP FOR CANCELLATION LIST FOR UPCOMING CLASS
*
SELECT DATE OF PSI CLASS
Select appropriate course/s
Selected Courses
CITY, STATE ZIP
EMAILS
3 Day
4 Day
PSI
4 Day Dealer
5 Day Dealer
ATTENTION RETURNING TECHNICIANS: TO RECEIVE 4 YEAR CERTIFICATE YOU MUST PROVIDE A CURRENT/VALID/NON EXPIRED CERTIFICATE NUMBER IN THE BOX BELOW
*
First time Student OR my certificate has already expired - Receive 3 Year Certificate
Other
PLEASE COMPLETE THIS FORM IN ALL CAPITAL LETTERS
*
LIST FULL LEGAL NAME OF A STUDENT - NO ABBRREVIATIONS
*
LIST COMPANY NAME OR FOR SELF-PAY LIST INDEPENDENT
*
BUILDING NO & STREET NAME
*
CITY
*
STATE
*
ZIP OR COUNTRY IF OUTSIDE U.S.
*
PHONE NO. OF A PERSON PAYING
*
STUDENT EMAIL
CC EMAIL/TO REGISTERING PERSONAL/OPTIONAL
*
S
M
L
XL
XXL
3XL
T-Shirt Size/Complimentary for KMDSI Class only
Must explain form of payment, if OTHER is selected. Example: I will bring a company check
*
I agree/will pay with credit card before start of class
Other
ANY QUESTIONS OR CONCERNS LET US KNOW BELOW - WILL GET BACK AS SOON AS POSSIBLE
ANY CHANGES TO THIS REGISTRATION MUST BE DONE WITHIN 48 HOURS
*
I understand that all the information I have provided in this registration form will be used to issue my certificate. Certificates are processed prior to class starting. I understand/agree that if I make any changes after 48 hours of registraion, I will be charged an additional processing fee of $40.00
FINAL CONFIRMATION
*
I agree to provide a final confirmation of my attendance 30 days prior to start of class. I understand that if I don't provide final confirmation my reservation may be cancelled
CANCELLATION POLICY
*
I agree to provide Dive Lab with a cancellation notice of minimum 30 days prior to start of class. I understand that if I do not provide 30 days notice of cancellation, a 50% cost of class charge may apply
SUBMIT
Should be Empty: