Discover Scuba Reservation

Is this your first time scuba diving?

Name *

First

Last

Phone Number(s) *

Email *

Notes

Additional Divers / Junior Divers (10-11 years old) / Certified Participants

How would you complete this sentence? "I am… *

You are welcome to elaborate on your answer in the Notes section above.

Date of Service *

Dive Times *

Credit Card Number *

Visa / Mastercard / Discover

Expiration Date *

Security Code *

3 digits on signature panel

Billing Address *

Street Address or PO Box

City / State / Zip Code

What is the name of your Hotel or Cruise Ship?

Directions to our shop available

Dates of arrival & departure*

* Flying is prohibited for a minimum of 12 hours after scuba diving

Phone