BOOKING FORM - FREEDIVER - BREATH HOLD

Name *
Name
Date of bith *
Date of bith
Information required for the PADI International Certification Card (C-card). [Confidential]
Address *
Address
[Confidential]
Payment information
For booking we require a non-refundable $100 USD deposit or the full payment.
Valid thru the last day of: *
Valid thru the last day of:
Please specify what is the amount you authorize to be charged to your credit card.
$
If different from activity beneficiary please present your iD copy or passport copy.