| Personal
Information |
| How
did you find our website? |
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| Name: |
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| Address: |
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| E-mail: |
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| Tel: |
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| Fax: |
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| Nationality: |
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| Preferred
language: |
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| Arrival
Date and Time: |
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| Departure
Date and Time: |
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| Proper
Hotel Name: |
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| Telephone
number of the Hotel: |
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| Current
certification level: |
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| How
many dives do you have? |
Dives |
| When
was your last dive? |
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| PADI
Courses |
| Kind
of Course: |
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| Please
select your specialty course: |
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| Please
check if a referral: |
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| Preferred
start date: |
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| Daytrips |
| Dive
Site: |
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| Date: |
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| Number
of Divers: |
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| Number
of Non-Divers: |
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| Liveaboard |
| Destination: |
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| Liveaboard
Code: |
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| Departure
Date: |
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| Number
of Days/Nights: |
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| Number
of Divers: |
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| Number
of Non-Divers: |
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| Equipment
(price includes equipment on some courses) |
| Do
you need equipment? |
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| Check
boxes for equipment requirements: |
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|
BCD |
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|
regulator |
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wetsuit |
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mask |
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fins |
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dive
light |
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underwater
camera |
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other |
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| note:
weight belts, weights and tanks are always included
|
| Accommodation |
| Do
you need help to arrange Accommodation? |
|
| Kind
of Accommodation: |
|
| Situated
at: |
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| Size
of room: |
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| Accommodation
location: |
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| Price
Range per room: |
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| Transportation |
| Transfer
to/from Phuket Airport |
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| If
YES, flight# & Arrival time |
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| Motorcycle
Rental request? |
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| If
YES, Date to rent? |
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| Additional
Information/Comments/Requests |
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*
We will e-mail back to you in your native language as
close to real time as possible. |
