【Jaimies dive center】Diving licence reservation form
下記のフォームに記入して「確定」ボタンをクリックしてください。（
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は必須項目）
name
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メールアドレス
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TEL
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date
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License acquisition course
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Openwater
advance
nitrox
intro tech
side mount
rescue
master scuba
equipment rental
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rent a full set
rent a part
no rental
(for suit rental) height cm
(For suit rental) Weight kg
(for suit rental) Foot size (cm)
Age (because a medical certificate may be required if you are over 50)
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hotel where you stay
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pick up
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I would like to pick you up
I don't want pick-up
Name of companion (if any)
Do you have any medical history or chronic illness? If yes, please write what kind of illness you have. If none, please write "none"
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questions, remarks
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