1 The Exact Names of All Members in My Party (Travel Ids)— Please include Ages of children:
2a My Phone #: 2b My Fax #:
3a My (Our) City of Departure:
3b My (Our) Home Address: 3c My (Our) Home City: 3d My (Our) Home State (or Country): 3e My (Our) Zip:
4 My (Our) Departure Date: 5 My (Our) Dive Adventure Destination: 6 How Many Nights Stay:
7a My (Our) Scuba Certifications with Org. (PADI, NAUI, SSI, etc.): 7b Respective Dates:
8 How Many Divers: 9 How Many Non–Divers: 10 Some of Us Snorkel (Y/N): 11 Some of Us Wish to Become Certified (Y/N): 12 While I Dive, the Others Enjoy:
13a I Dived (How Many Dives?) During Last 12 Months: 13b My Last Dive Was At: 13c On (Month/Year):
14 I Bring Along the Following Personal Equipment:
15a I will Dive Any Diveable Wave/Current Conditions (Y/N): 15b I Prefer Gentle Wave/Current Conditions (Y/N):
16a Best Dive I Ever Had Was At: 16b It Was Outstanding Because:
17 My (Our) Other Activities Include:
18a We Prefer a Resort Atmosphere with Beach, Pool Bar, Watersports, Room with View, Etc. (Y/N): 18b We Prefer Moderate Accommodations with Some Amenities (Y/N): 18c We Prefer Spartan Living Accommodations (Y/N): 18d We Prefer a Condo (Y/N): 18e We Prefer a Live–Aboard Dive Adventure (Y/N):
19 We Seek the Following Dive Adventures:
20 We Seek the Following Non–Diving Adventures:
21 Here's Some More Information For Our Best–Valued, Customized Travel and Dive Adventure: