TRAVEL APPLICATION FOR CURACAO NETHERLANDS ANTILLES

An Omni Divers Underwater Services, L.L.C. and
Omni Travel Adventures Group Trip

October 8 - 16, 1999
DIVERS $1,745 per person double occupancy
NON DIVERS $1,400 (with a Diving Buddy) per person double occupancy
Airfare from Boise - your cost may be different!

Payment Schedule as of June 2, 1999.
A $400 nonrefundable deposit is due with this application.
Additional $400 due July 1, 1999.
Additional $400 due July 15, 1999.
Final balance of payment is due August 1, 1999 otherwise you will forfeit your deposit and your space will be automatically released.
All prices are subject to change until paid in full. Monthly payments are available. Mastercard/Visa is accepted for airline fare only.
Each Traveler Must Complete the Following:

Please print out form and send to Phil or Bill.

Legal Name ________________________________________________________

Birthdate ________________________       U.S. Citizen?   YES     NO

Address __________________________  City _______________  State ___

Telephone Home ___________________  Telephone Work ________________ 

FAX ____________________            e-mail ________________________

Rooming With ______________________________________________________

Passport Number ___________________ Expiration ____________________

Are you a certified diver?   YES   NO 

Certification Agency and Number ___________________________________

Number of Dives _____________________
Number of Dives in the past year _______________
Date of Last Dive ___________________

DAN Insurance Required! 
(or similar diver accident insurance coverage)  YES   NO
DAN Insurance Number __________________________________
Would you like to arrange monthly payments?  YES   NO

Emergency Contact Not Traveling With You:
Name ______________________________________Relationship ___________
Telephone __________________________

Omni Divers Underwater Services, L.L.C. and Omni Travel Adventures arranges for your travel services with reputable hotel, airline and other independent suppliers who provide the service you purchase. However, Omni Divers Underwater Services, L.L.C. and Omni Travel Adventures does not have direct control over them; therefore Omni Divers Underwater Services, L.L.C. and Omni Travel Adventures, its directors, agents and employees assume no responsibility or liability for the weather, services, transportation or equipment made available or as to its safety, quality or condition, nor for acts of any employee or agent of any establishment, firm, person or entity furnishing such service, transportation or equipment. Nor does Omni Divers Underwater Services, L.L.C. and Omni Travel Adventures, its directors, agents and employees assume any responsibility or liability for the safety of any participating client engaged in water activities above or below the water. We are committed to your satisfaction and thank you for your business and cooperation.

Signature ____________________________________ Date ___________________

Deposit Date ___________________
Amount: ___________ Credit Card MC/V _________ Cash ___ Check No. _____

Payment Date ___________________
Amount: ___________ Credit Card MC/V _________ Cash ___ Check No. _____

Payment Date ___________________
Amount: ___________ Credit Card MC/V _________ Cash ___ Check No. _____

Payment Date ___________________
Amount: ___________ Credit Card MC/V _________ Cash ___ Check No. _____

Trip Brochure __________________
Trip Insurance Brochure _________________
DAN Insurance Brochure __________________

Omni Divers Underwater Services, L.L.C.
Omni Divers Underwater Services - - ODUS - Omni Divers - Omni Travel Adventures
This page was last updated on Fri May 26, 2000 12:00:00 AM- Created by All Are Rights Reserved