Scubajive Booking Form

SCUBAJIVE

BOOKING

FORM

SCUBAJIVE

BOOKING

FORM

Please fill in this form and fax it to: 0034 950 473 136

Name:

______________________________________________________________________________________

Address:

______________________________________________________________________________________

______________________________________________________________________________________

____________________________________________Post / Zip Code_____________________________

Phone Number:

______________________________________________________________________________________

Fax Number:

______________________________________________________________________________________

E-mail Address

______________________________________________________________________________________

Diver's Names & Ages:
(Current diving certification if applic)

_________________________________________________________________ Age: _________

_________________________________________________________________ Age: _________

_________________________________________________________________ Age: _________

_________________________________________________________________ Age: _________

_________________________________________________________________ Age: _________

_________________________________________________________________ Age: _________

(circle as appropriate)

DIVE COURSE / GUIDED DIVES

(tick as appropriate)

DISCOVER SCUBA DIVING
OPEN WATER DIVER
ADVANCED DIVER
EFR
RESCUE DIVER
DIVEMASTER
OTHER (specify) ____________________

Dates of Diving:

From::________ / ________ / _________

To: ________ / _________ / _________

Accommodation Required?

YES / NO

Airport Collection Service Required?

YES / NO

Hire Car Required?

YES / NO

PAYMENT DETAILS

Name on Card:

______________________________________________________________________________________

Card Type (circle):

Visa / Mastercard

Card Number:

______________________________________________________________________________________

Expiration Date:

_______ / _______ / ________

Amount to Pay:

_________________________ (Pounds / Euros ?)

Signature:

Please fax this completed form to Scubajive.
Fax No: 00 34 950 473 136

Due to costs incurred all cancellations on pre booked diving will be charged a 20% charge of total costs.
This cancellation charge will be reimbursed when re-booking.