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Travel or Group Tour Application

Please complete fully and then hit submit button at bottom of page

Or download a PDF application form and mail, fax or hand-deliver

Personal Information

Full Name:       Date of Birth:        Age:

Street: City: State: Zip Code:

Gender:                Vegetarian:

E-mail address:

Day phone:             Evening phone:


Passport No:

Date issued: Where: Expiration date:


Medical Information

Do you have any medical conditions, history or physical impairments that can make diving or other underwater activity dangerous to you or others?:    

If yes, please specify:

Physician's Name: Phone:

Street address: City: State: Zipcode:


Diving Experience

Years diving:     Main Diving Interests:

Previous Dive Experience:

Diving ability:            

General Information

Airline seat preference:

Special Dietary Requests: Date:

Airport Departure: Departure Date:

Emergency Contact (Mandatory per USDOT rules effective Jan. 1, 2003)

Contact Name: Contact Phone:

Comments & Requests:


Dive Travel Services, 29480 Ten Mile Road, Farmington Hills, MI 48336

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