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PERSONAL INFORMATION
Your name
Country of Origin
Email Address
ACCOMMODATION
How many people are in your group?	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 more than 15
Number of nights?	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 more than 15
Date of arrival?	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 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 2006 2007 2008 2009 2010 2011
Staying at Pondok Baruna?	Yes      No
Number of double rooms required?	0 1 2 3 4 5 6 7
Number of twin bed rooms required?	0 1 2 3 4 5 6 7
FUN DIVES
How many certified divers are in your group?	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 more than 15
Roughly, how many dives per person during your stay?	1-2 3-5 6-8 9-12 more than 12
Please let us know your certification level and organisation, number of dives and when you last dived. (NB: don't forget to bring your certification card!)
COURSES
Please check which course(s) you or your group are interested in taking	Discover Scuba Diving PADI SCUBA Review PADI Open Water Course PADI Advanced Open Water Course PADI Medic First Aid Course PADI Rescue Course PADI DiveMaster Course
OTHER
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