Registration Form Dune Liveaboard

Destination:

Select destination Egypt Indonesia Maldives Saudi Arabia Sudan Djibouti

Cruise date: (choose destination first)

Select date

Booking Code:

Title:

Select title Mr Ms

Name:

Surname:

Date of Birth:

Nationality:

Passport No.:

Expiry date:

Address (street, no):

Town:

State:

ZIP:

Country:

Email:

Phone number (with country code):

Are you sharing your room? If yes, please give us the name of your buddy/lover/wife/husband/friend etc.:

Double Bed or Twin?

Name:

Phone:

Email:

Relation:

Allergy/specific diet (vegetarian, Gluten Free etc):

Are you taking any medication? If yes, please just tell us which one:

Have you any chronical disease (as blood pressure, asthma etc)?

Is it your first trip on Dune Liveaboard? If not, how many time have you already joined us for a cruise?

Dive certification LEVEL and certification agency (PADI, CMAS etc):

Certification DEEP DIVE/PA40 (Y/N):

Nb of dives:

Date of last dive:

Tell us just a little bit more about the amazing places you have been diving in:

Nitrox certification (Y/N):

Name of DIVING INSURANCE:

CONTRACT N°:

Insurance phone number:

15 L Tank (Y/N):

Private guide (Y/N) (with extra payment):

Are you an underwater photographer/video maker (Y/N)?

What do you need?

If you don't need a pick up at the airport, just let us know and we will confirm you a meeting point and time

Do you have any further questions or information you want to share with us?

*You can only submit if you have filled in all the required information.