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DIVER PROFILE FORM
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Trip Details
  Departure Date Return Date Trip Reference

Where / how did you hear about us?

Internet search UE Website Research Friend/word of mouth Repeat guest
Travel Agent Magazine Documentary   Other
Passenger Details
Name Date of Birth
Permanent Address City
State Post Code
Country Gender Male Female
Phone Email
Dive Qualifications & Experience
Certification Agency Certification No Certification Level:
(Open Water/Advanced etc)
Number of dives Date of last dive Number of dives in last 12 months
Deepest dive Have you dived in the ocean? Have you done a night dive?
Nitrox Certification Level (if applicable) Nitrox Certification Agency (if applicable e.g TDI, PADI)
Other Information
Do you have any special dietary requirements?
(allergies, vegetarian. etc)		 Details:
Do you have any medical conditions
(such as epilepsy/asthma/diabetes/decompression sickness /allergies, etc)
that are relevant to diving, that we should be aware of?
 		 YES NO
If yes please provide details:

If “yes” we require a letter from a Doctor trained in diving medicine stating that you are fit to scuba dive with your condition.
Emergency Contact
Name:  Relationship: Email:
Address Phone:
Dive Requirements
Please tick if a course is required. Hire of Dive Gear and Dive Courses are payable onboard the vessel.
 
Refresher Course $55 Nitrox fills required? ($10/fill or $20/day payable on board)
PADI Advanced Course $200 PADI Nitrox Course $200
Note: Qld regulations state that nitrox course participants
must be certified and have a min of 20 logged dives.
   I am bringing my own dive gear
or

If you require gear hire please tick the items and size required:
Full Set Gear Inc. Computer @ $200.00/week or $100.00/3 days XS S M L XL XXL XXXL
or    
Wetsuit @ $35.00/week or $18.00/3 days XS S M L XL XXL XXXL
B.C.D. @ $70.00/week or $35.00/3 days XS S M L XL XXL XXXL
Regulator & Computer @ $100.00/week or $50.00/3 days  
Mask / Fins / Snorkel @ $35.00/week or $18.00/3 days Foot size:
Computer Only @ $50.00/week or $25.00/3 days A dive computer is compulsory on Undersea Explorer
Torch @$45.00/week or $20.00/day Torch not included in Full Set of gear
Please Note: A clean fuel levy for use of bio-diesel of $15 per day is payable onboard, in addition to an environmental management
charge of $15 per trip. These charges are subject to change.
Diving Insurance. 30-day DAN TravelAssist which covers remote area evacuation is included in your expedition cost. Please
complete the attached form and return to us along with this form. If you require yearly membership we recommend this to be taken out prior to travel with us and please contact DAN directly in your country of residence. We also recommend taking out separate travel insurance that covers trip cancellation, which you must arrange prior to travel.
I already have DAN Membership or Diving insurance?
Insurance
Membership No.		 Insurance
Organisation:		 Insurance
Contact Phone:
If you do not wish to be on our database please check the box

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the Undersea Explorer's Liability Release Form