Application form for activity
Your application will be completed when you click "submit" button in the confirmation page.
Date of activity
If you will participate for several days, You should only put the 1st date.
Date of activity
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
Name of Emergency contact person
Name of Emergency contact person
Phone number of Emergency contact person
Phone number of Emergency contact person
Relationship
Relationship
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.
Name of Emergency contact person
Name of Emergency contact person
Phone number of Emergency contact person
Phone number of Emergency contact person
Relationship
Relationship
Your height
Your height
Your weight
Your weight
Your foot size
Your foot size
Do you wear glasses or contact lenses?
Yes, I wear glasses.
Yes, I wear contact lenses.
No, I do not wear glasses or contact lenses.
What is your [eye/glasses] prescription?
What is your [eye/glasses] prescription?
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
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 activity