Scuba Camp Registration

Filling out this form does not guarantee a spot in class. Divers can reserve their spot by paying with a credit card over the phone or by dropping off payments to our visiting center.

Scuba Camp

First Name: *

Middle Name:

Last Name: *

Birth Date:

Height:

Weight:

Email Address: *

Mobile or Best Phone #: *

Sex:

Female

Male

Address:

Street:

City:

State: -- State -- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Zip:

Personal Info

Class Type: * Scuba Camp Without Equipment - $800 Scuba Camp With Equipment - $700

Total $:

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