Caribbean Scuba Trip Deposit Caribbean Scuba Trip Deposit Your Trip Learn To Scuba Lake Norman Scuba Your Trip Legal Name * Legal Name First First Last Last Email * Phone * Your Date of Birth * What scuba certification do you hold * When was your last logged dive? * Your roommate’s information Legal name of your roommate * Roommate’s Date of Birth * Email * Phone * What scuba certification does your roommate hold * When was your roommate’s last logged dive * Are you interested in upgrading your room to club or butler level? Yes No How did you hear about us? Your Billing Information Address * Address Street Address Street Address Building/Suite/Apartment # Building/Suite/Apartment # City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Credit Card * Acknowledgement of the full payment amount due * I understand that full amount of the trip cost is due 95 days before the trip Acknowledgement of the refund policies * I understand that $250 of this $500 deposit is refundable 95 days before the trip, with $50 going as a store credit with the scuba shop. Submit If you are human, leave this field blank.
