Email Guests full name as it appears on passport. Preferred name / nickname (how we should greet you): Mobile Phone Gender Female Male Date of birth: Address: City State Zip PASSPORT (required for international travel & required by hotel) Passport expiration date Passport date issued: Country issuing passport: Country of citizenship: Photo of passport biographic page. I am on the group AA flights. No Yes Non-group / independent flights: Airline: CUR arrival time: CUR departure time: Emergency contact NOT traveling with you: ER Mobile Number SCUBA INFORMATION - Agency: PADI SSI NAUI SDI/TDI N/A - Non-Diver Other Other Agency: Highest scuba certification (N/A for non-divers) Open Water Diver Advanced Open Water Diver Rescue Diver Divemaster Assistant Instructor Open Water Scuba Instructor Master Scuba Diver Trainer IDC Staff Instructor Master Instructor Course Director N/A - Non-Diver Scuba certification number (N/A for non-divers): Last dive: Within 1 month Within 6 months Within 12 months Over 12 months — refresher needed (we can help) N/A non-diver Need to discuss a refresher (not dived within the 1-year agency standard)? Yes No N/A - Non-Diver Nitrox certified — Nitrox fills are included in trip cost Yes No N/A - Non-Diver Preferred valve: DIN YOKE N/A - Non-Diver DAN insured (or equivalent dive accident insurance): Yes No N/A - Non-Diver If yes, policy name / number (N/A - Non-Diver): Approximate total number of dives? (0 - Non-Diver): Lionfish certified: Yes No N/A - Non-Diver Want to get the Lionfish Certification on this trip? Yes No N/A - Non-Diver Shirt / trip rash guard size — unisex, runs true to size Small Medium Large XLarge 2XLarge 3XLarge Monday lunch (divers ONLY): Italian Cold Cuts Chicken Salad Vegetarian Non-Diver - N/A Anything the trip lead, DM, or hotel should know? PHOTO / VIDEO & ACKNOWLEDGMENT Yes — you may use my image. Please make a reasonable effort not to feature me in close-ups. Instagram handle to tag? Send
