Aquaventures PNG Ltd DMV Kamai

PO Box 166, Madang Papua New Guinea

PH/Fax (675) 853 3123 e-mail aquaventures@global.net.pg

Name

Date of Birth

Address

Contact Ph/Fax

E-mail

Departure Date of Trip

Trip Detail

Certification Level/Date

# Dives experience

Hire Equip Required

Dietry Requirements

Special Requests

PADI Dive Courses Requested

Required Dive Equipment - Safety Sausage, Signaling Device, Dive Light (for Night dives), Regulator with Yoke Screw NOT DIN fitting.

Medical Statement - I state that I am in good health for diving. I have no medical history of heart or lung disorders, asthma, or epilepsy, nor am I an Insulin dependant diabetic. I will not dive if I am feeling unwell or suffering from a cold or respiratory disorder nor will I dive under the influence of Alcohol or Drugs. I understand if I have a medical condition contrary to these requirements I will produce a current medical certificate. Aquaventures PNG is duly authorised to make medical and transport arrangements as may be determined in my best interest. I agree to pay any expenses incurred on my behalf.

Discharge of Liability - I (name)                                                           , discharge Aquaventures PNG Ltd and its employees and agents, that to the extent permitted by law Aquaventures PNG Ltd its employee's and agents is discharged by myself and my executors, administrator, dependants from any liability for any damage, death or injury what so ever arising out of or incidental to this dive cruise, whether or not such damage or injury is caused or contributed to by Aquaventures PNG Ltd its employee's and its agents.                                                                                                                                                                            I further acknowledge I am aware of the risks of injury associated with my participation in this dive cruise and agree that I voluntarily assume such risk of injury.

Cancellation Policy:

-25% deposit - Non refundable

-30 days prior to departure forfeit 50% of trip cost

-7days to departure day 100% forfeiture of trip cost

Travel Insurance - I accept responsibility for any unforeseen circumstances which may affect my trip and have taken out travel insurance or accept the financial risk for change in the trip.

Single Supplement - Guests wishing a single room for themselves add 75% of Trip Cost

Statement of Understanding - By signing below I have read ,understand and accept the Discharge from Liability and the conditions set out above

Date 

Signature

Cost Confirmation

Deposit Due Date

Payment Details