Registration Form

Registration Form
1. Client Details
Name*
Address *

Street Address

Street Address Line 2

CityCounty / State / Province

Postal / Zip CodeCountry
Phone number*
That you can be contacted on whilst on holiday
Email*
A copy of your form will be emailed to you
2. Emergency Contact
Name*
Relationship*
Address *

Street Address

Street Address Line 2

CityCounty / State / Province

Postal / Zip CodeCountry
Phone number*
Email (optional)
3. Dive & Travel Insurance
Insurance provider*
Policy number*
Emergency contact number*
4. Dive Experience
Certification agency*
Certification level*
Number of dives*
Date of last dive (dd/mm/yy)*
Nitrox certified*
Bringing an UW Camera?
5. Equipment Rental
Please tick the items you wish to rent

BCDRegsMaskFinsWetsuitDive ComputerDive Torch
Height (cm) - required if renting BCD or Wetsuit
Weight (kg) - required if renting BCD or Wetsuit
Shoe size (European) - required if renting Fins
Special equipment requests
6. Special Dietary Requests
Please list any special dietary requests
7. Medical Conditions
Please list any medical conditions
Should be Empty: