Liveaboard Departure Date
Choose...11 October 1016 October 1021 October 1026 October 1031 October 1005 November 1010 November 1015 November 1020 November 1025 November 1030 November 1005 December 1010 December 1015 December 1020 December 1025 December 1030 December 1004 January 1109 January 1114 January 1119 January 1124 January 1129 January 1103 February 1108 February 1113 February 1118 February 1123 February 1128 February 1105 March 1110 March 1115 March 1120 March 1125 March 1130 March 1104 April 1109 April 1114 April 1119 April 1124 April 1129 April 11

Type Of Cabin
Top Deck Double Bed Cabin (2 people sharing same bed)Main Deck Double Bed Cabin (2 people sharing same bed)4 Person bunk bed cabin

Personal Details:
Your Name (required)

Your Email (required)

Your Nationality (required)

Your Age (required)

Special Dietary Requirements? Please let us know

Your Residential Address
Please Enter Your Residential Address and Post Code

Your Phone Number

Scuba Diving Details:
Your Dive Certification:
Choose...Never dived before - want to learn!Open Water DiverAdvanced Open WaterRescue DiverDivemasterInstructor

Dive Certification Agency
Choose...PADIBSACSSINAUICMASSDIOther - please specify in Comments box at bottom

Number Of Dives

Date Of Last Dive

Do You Have Dive Insurance?
 Yes No

If no, we recommend World Nomads travel insurance that includes scuba diving coverage

Emergency Contact Information
Emergency Contact Name (required)

Emergency Contact Phone Number

Emergency Contact Address
Please Enter Your Contact's Address and Post Code

Your Dive Gear Sizes
(If you are learning to dive with us, you do not need to fill in this part)

BCD
Choose...XSSMLXLXXL

Fins
Choose...UK: 3 Europe: 36 USA: 4UK: 4 Europe: 37 USA: 5UK: 5 Europe: 38 USA: 6UK: 6 Europe: 39 USA: 7UK: 7 Europe: 40 USA: 8UK: 8 Europe:41 USA: 9UK: 9 Europe: 42 USA: 10UK: 10 Europe: 43 USA: 11UK: 11 Europe: 44 USA: 12UK: 12 Europe: 45 USA: 13UK: 13 Europe: 46 USA: 14

Wetsuit
Choose...XSSMLXLXXL

Dive Computer - 400 Baht per day  Yes

Digital Camera - 1000 Baht per day  Yes

Dive Courses - please check all that apply
PADI Open Water Diver Student Liveaboard Package 28700 Baht  Yes

PADI Advanced Open Water Course 7500 Baht  Yes

PADI Rescue Diver Course 9000 Baht  Yes

Emergency First Responder Course 4000 Baht  Yes

PADI Divemaster Course 35000 Baht  Yes

Taxi Pickup
Do you require taxi pickup from Phuket Airport (1200 Baht?)  Yes

Any Further Comments? Let Us Know