HoldMySpotRegistration

Hold My Spot!

First Name

Last Name

Street Address

City

Region/State/Province

Postal / Zip code

Code

Phone

Your Birthdate (Day, Month, Year)

Passport Number (If International Escape)

Expiration Date

PADI # (Enter Student if Not Certified Yet)

PADI Certification Level (Student, OW, AOW, Rescue, Etc)

My Travel Companion's Name Is:

Companion's Email

Companion's Phone

Companion Date of Birth (Day, Month, Year)

Companion Passport Number

Companion's Expiration Date

Companion's PADI #

Companion Certification Level

I understand this is a nonrefundable deposit to hold my spot on the scuba escape I have indicated below. This will block others from taking this spot. Final price of the trip will be available within 30 days of deposit. I agree that any photos taken of me while on this trip are the property of Southeast Scuba Escape and may be used for marketing purposes without furthe permission from me and without compensation. I understand I must meet medical standards an PADI medical questionaire may require a physican clearance to dive. I also understand that I should ensure my passport has at least 6 months before expiration from the date of my return from international destinations, and that I should purchase travel insurance to protect my investment in this vacation. SoSE is not able to refund expenses for this or other escapes should I not be able to attend afte registering and paying. SSE will host a bon voyage meeting at least 2 weeks prior to departure in person or via Zoom to review final details and get participants together to meet, review gear needs, and go over all travel and escape details and requirements.

Your Signature

Companion Signature (Enter None if No Companion)