Application form for fun dive
Your application will be completed when you click "submit" button in the confirmation page.
Date of dive(1st day)
If you will participate for several days, You should only put the 1st date.
Date of dive(1st day)
Name
Name
Nationality
Nationality
birthday
----
年
--
月
--
日
Age
Age
Gender
male
female
Address
I am a resident of Palau.
I am a non-resident of Palau.
Address
Address
Which hotel do you stay in Palau?
Which hotel do you stay in Palau?
Phone number
Phone number
e-mail
e-mail
Emergency contact person
Please do not input your travel companion as an emergency contact.
Emergency contact person
Relationship
Relationship
Phone number
Phone number
Do you have any another emergency contact person?
Yes. I have another emergency contact person.
No.I do not have any another emergency contact person.
Emergency contact person
Please do not input your travel companion as an emergency contact.
Emergency contact person
Relationship
Relationship
Phone number
Phone number
Dive experience
How many dives have you taken?
Dive experience
When was your last dive?
When was your last dive?
Association
PADI
NAUI
SSI
BSAC
CMAS
OTHERS
Certification level
OPEN WATER
ADVANCED OPEN WATER
RESCUE DIVER
DIVE MASTER
INSTRUCTOR
OTHERS
How many times have you visit to Palau ?
first time
second time
third time
fourth time and more
I am not sure
How many times have you visit to Cruise Control ?
first time
second time
third time
fourth time and more
I am not sure
Do you need any rental equipment?
I like to rent some dive equipment.
I have own all dive equipment.
Rental equipment
Regulator
BCD
Wet Suits
Mask
Booty
Fins
Gloves
Diving Computer
marker buy
the others
under water camera
Which dive equipment do you like to rent?
Which dive equipment do you like to rent?
Foot size
Foot size
Mask
with prescriptions of lenses
without prescriptions of lenses
What's your [eye/glasses] prescription?
What's your [eye/glasses] prescription?
Weight and Height(Wet Suits)
Weight and Height(Wet Suits)
Weight and Height(BCD)
Weight and Height(BCD)
Are you a certified diver for Nitrox?
I am a certified diver for Nitrox.
I am not a certified diver for Nitrox.
I am not sure
Which gas do you like to use?
Nitrox cylinder (32%)
Air cylinder
others
Which type of Diving permit do you like us to prepare?
$50 type（diving permission）
$100 type（diving and Jelly fish lake permission）
others
to the confirmation page
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Application form for fun dive