CRUISE RESERVATION FORM

Please complete this form in order to reserve your dive-cruise space with Hooked on Diving. Please note that the sections with an " * " are mandatory, as we need this information to reserve your space. Any additional information that you provide will only help us serve you better. The information that you provide will be held in the strictest confidence, under no circumstances will any information be distributed to a third party. 

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  1. Please enter the departure date of the cruise you wish to reserve:

-- dd/mm/yy-*

2nd. Choice:

-- dd/mm/yy-*

3rd. Choice:

-- dd/mm/yy-*

  1. If you are a returning H.o.D. client, please provide your H.o.D account number:
Password *
Confirm Password *
  1. Please provide the following contact information:
First Name *
Last Name *
Title
Organization
Street Address *
Address (cont.) *
City *
State/Province *
Zip/Postal Code *
Country *
Work Phone *
Home Phone *
FAX
E-mail
URL
  1. Please identify and describe yourself:
Date of Birth *
Sex Male Female*
Height *
Weight *
  1. Please enter how many dives you have made in the past six months.

*

  1. Have you been medically cleared to dive by a doctor?

Yes No    *

  1. Do you suffer from any medical condition that may preclude your full participation in a dive cruise?

Yes No    *

  1. If yes, please give details. *


  1. Have you ever suffered from sea sickness?

Yes No   *

  1. Please provide information on an emergency contact person:
First Name *
Last Name *
Work Phone *
Home Phone *
FAX *
E-mail *
  1. In order to help us serve you better, please indicate you specific diving interest(s).
Coral Garden	Blue Hole	Large Fish/Pelagic		     
Cave / cavern 	Sharks    	Wall / Drop Off 	  
Tunnels / Cuts   	Reef Fish	Wrecks
  1. Please indicate your preferred diving activity(s):
 General viewing
 Photography (Still)
 Photography (Video)
  1. Please indicate your preferred diving style(s).
Shallow	Deep	Multi-level		Drift      
Search	Night	Wreck Penetration
  1. Please enter your association and your level of certification: 

          (i.e. PADI / Open Water)*

  1. Please list any specialty certifications you have.

         (i.e. Night Specialty)

  1. Are you Nitrox certified?

Yes No

  1. Are you interested in upgrading your certification during this cruise?

Yes No

  1. If yes, please select any courses that interest you:

Discover Scuba
Open Water Certification Course
Open Water Certification Dives
Advanced Open Water
Advanced Open Water Plus
Rescue Diver
Medic / First Aid
DAN Oxygen Server
Divemaster
Assisting Instructor
Master Scuba Diver
Underwater Navigation Specialty
Night Specialty
Deep Specialty
Boat Specialty
Naturalist Specialty
Multi-level Specialty
Wreck Specialty
Drift Specialty
Equipment Specialist
Photography Specialty
Video Specialty
Nitrox Specialty

  1. Please enter any other courses or specialties that interest you, but are not listed above.

 
Hooked on Diving (Marketing Form 9909).
Copyright © 1999 [Hooked on Diving]. All rights reserved.
Revised: May 10, 2001.