Yes...Quote Me Happy...
On My Special Islands Micronesian Dive Adventure

(Bikini, Guam, Kosrae, Pohnpei, Saipan, Tinian & Rota, Ulithi)

To offer you your best–valued, customized Dive Adventure,
please tell us more about yourself(ves). Thank you—

My Name:
My Email Address:
Note: We need your Email address in order that we can contact you.

1. The Exact Names of All Members in My Party (Travel Ids)—Please include Ages of Children:

2a. My Phone #:
2b. My Fax #:

3. My (Our) City of Departure:

4a. My (Our) Home Address:
4b. My (Our) Home City:
4c. My (Our) Home State (or Country):
4d. My (Our) Zip:

5a. My (Our) Departure Date—1st Choice:
5b. My (Our) Departure Date—2nd Choice:
5c. My (Our) Departure Date—3rd Choice:

6a. Other Micronesia Destination—1st Choice:
6b. My (Our) Preferred Land Accommodations—1st Choice:
6c. My (Our) Preferred Land Accommodations—2nd Choice:

6d. Other Micronesia Destination—2st Choice:
6e. My (Our) Preferred Land Accommodations—1st Choice:
6f. My (Our) Preferred Land Accommodations—2nd Choice:

6g. Other Micronesia Destination—3st Choice:
6h. My (Our) Preferred Land Accommodations—1st Choice:
6i. My (Our) Preferred Land Accommodations—2nd Choice:

6j. Other Micronesia Destination—4st Choice:
6k. My (Our) Preferred Land Accommodations—1st Choice:
6l. My (Our) Preferred Land Accommodations—2nd Choice:

6m. Other Micronesia Destination—5st Choice:
6n. My (Our) Preferred Land Accommodations—1st Choice:
6o. My (Our) Preferred Land Accommodations—2nd Choice:

7. How Many Nights Stay—(the longer you stay, the more islands you can visit):

8a. My (Our) Scuba Certifications with Org. (PADI, NAUI, SSI, etc.):
8b. Respective Dates:

9. How Many Divers:
10. How Many Non–Divers:
11. Some of Us Snorkel (Y/N):
12. Some of Us Wish to Become Certified (Y/N):

13. While I Dive, the Others Enjoy:

14a. I Dived (How Many Dives?) During Last 12 Months:
14b. My Last Dive Was At:
14c. On (Month/Year):

15. I Bring Along the Following Personal Equipment:

16. We Seek the Following Dive Adventures:

17. We Seek the Following Non–Diving Adventures: