1. Which Island will you be visiting? Oahu Hawaii

2. Name:

3. Street Address:
City: State/Province:
Country: Postal Code:

4. Phone Number

5. Your E-mail address:

6. What hotel will you be staying at?

7. When will you arrive in Hawaii? Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2004 2005

8. How long will you be staying? 1 day 2 days 3 days 4 days 5 days 6 days 1 week 10 days 2 weeks 3 weeks 1 month more than 1 month

9. What day would you like to start diving? Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

10. How many days will you be diving? 1 day 2 days 3 days 4 days 5 days 6 days 1 week 10 days 2 weeks 3 weeks 1 month more than 1 month

11. How many people are in your group? 1 person 2 people 3 people 4 people 5 people 6 people 7 people 8 people 9 people 10 people

Below please select your type of diving.

A. Introductory Diving If you are not certified, you can still dive with one of our instructors. SNUBA at Hanauma Bay or Disover Scuba - 1 Dive (Beach) Discover Scuba Diving - 2 Dives (Beach and Boat)
B. Pleasure diving in Oahu or Kona. Guided dives for certified divers. How many dives would you like to do each day? 2 dives 3 dives What is your certification level? Scuba Diver Open Water Diver Adventure Diver Advanced Open Water Rescue Diver Master Scuba Diver Divemaster Assistant Instructor Instructor How many dives have you made? When was your last dive?
C. Certification Courses Get your PADI Diver Education card here! Course: Scuba Diver Open Water Diver Adventure Diver Advanced Open Water Specialty Course Rescue Diver Master Scuba Diver
D. Professional Dive Course Go Pro! Become a PADI professional. Professional Course: Divemaster Emergency Frist Response Instructor Assistant Instructor Instructor Specialty Instructor Master Scuba Diver Trainer IDC Staff Instructor