Diving Sea Safari
Indonesia diving leisure expedition, Bali Indonesia liveaboard, Bali diving, Alor liveaboard, diving Komodo, liveaboard Indonesia.

Passenger Form

(Please enter per person)

Diving Trip

Departure : until
Destinations :

Personal Detail

Full Name :
(As per passport)
Phone :
Greeting Name :
(How do you normally like to be greeted? e.g. Fred)
Email Address : Gender : Male   Female
Nationality : Date of Birth :
Passport No : Passport Expiry :
Group Name :
(If traveling in a group, type a name to identify your group)

Emergency Contact

Dive Insurance

Name : Company :
Phone : Policy No :
Relationship : Expiry :
   Phone :
Medical Record:

Diver Profile

Certification Level: Non Diver  On Course  Junior Open Water   Open Water   Advanced OW  Rescue  Dive Master  Instructor  
Certification Org: PADI  SSI  BSAC  NAUI  Other  
No. of dives: None  Less than 10  10-50  51-100  More than 100  I Lost Count  
Last Dive Date:
Nitrox Certified?:  (Yes I'm certified to dive Nitrox)
Nitrox This Trip?:  (Yes I would like to dive Nitrox on this trip. Charges Apply)

Courses Available

The following courses can be conducted onboard. If you are interested in completing any courses on this trip please make your selection below.

Please Select:

DIVE EQUIPMENT RENTAL

Snorkling Equipment (mask,snorkel,fins) USD 15.00/day
Mask USD 5.00/day
Snorkel USD 5.00/day
Fins USD 5.00/day
Wetsuit USD 7.00/day
Regulator USD 7.00/day
Bcd USD 7.00/day
Torch & Batteray USD 8.00/day
Batteray USD 1/piece
Dive Computer USD 10.00/day
Camera Underwater USD 20.00/day
Complete Equipments USD 35.00/day
Complete Equipments Package USD 200.00/package
Nitrox USD 10/bottle
Nitrox Package USD 20/day
Make Video Underwater Proffessional Package USD 300/day

PADI Courses

Discovery Scuba Diving
USD 125
Scuba Diver USD 380
Open Water Course USD 405
Advanced Open Water USD 305
EFR USD 100
Rescue Diver USD 345
Equipment Size
*please tell us the size of equipment you need.

Flight and Accommodation Details (if Applicable)

Flight Details: Flight NumbersDateTime
Arrival:
Departure:
Accommodation
Hotel Name:

Additional Information

Meal Preference :
(Please let us know if you have special food requirements)
Dietary Restriction :
Questions or Comments :

Terms and Conditions

Insurance: Our trips are not inclusive of any form of insurance. We advise all customers to consider both travel insurance as well as dive insurance. Dive insurance is available at DAN http://www.danasiapacific.org under Membership and Insurance.