Registration Jupiter FL 2023

Women's Dive Day - Mermaids in Jupiter (Florida) 2023 Registration

First Name

Last Name

Street Address

City

Region/State/Province

Postal / Zip code

Phone

Your Birthdate (Day, Month, Year)

Number of Dives Total

Date of Last Dive

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 Number of Dives Total

Companion's Date of Last Dive

Companion's PADI #

Companion Certification Level

Please note any allergies here as well as any other special concerns we need to be aware of for you.

Travel Companion: Please note any allergies here as well as any other special concerns we need to be aware of for you.

I understand that deposits are nonrefundable. This will block others from taking this spot. Final payment of remaining balance of the trip cost is due 60 days prior to departure and I will receive an invoice. I agree that any photos or videos or likenesses taken of me or my children while on this trip or while at any SSE event are the property of Southeast Scuba Escape and I authorize SSE to use them without further authorization or compensation to me or my family for promotional and marketing purposes. I understand I must meet medical standards an PADI medical questionaire may require a physican clearance to dive. I also understand that I may be required to have proof of COVID-19 Vaccination in some locations/countries, and that I should ensure I understand those requirements. If this is an international trip, I will ensure that my passport has at least 6 months before expiration from the date of my return from international destination. I understand that SSE has recommended that I should purchase travel insurance to protect my investment in this vacation. I can purchase insurance on the SSE home page under the DAN link if I desire. I understand that Southeast Scuba Escape (SSE)is not able to refund the cost for this or other escapes should I not be able to attend after registering and paying for the trip. SSE will host a bon voyage meeting 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 which I will endeavor to attend. I am responsible to provide all required and requested information needed to coordinate my participation in this trip.

Your Signature

Companion Signature (Enter None if No Companion)

If registering a travel companion please remember to select the appropriate number of deposits to pay. If registering more than one travel companion please complete a separate registration.

I will register additional travel companions: