Travel > Dominica 2000 > Dominica Application 2000
DOMINICA
October 13 - October 22, 2000
An Omni Divers Underwater Services, L.L.C. and
October 13 - October 22, 2000
Cashiers Check for Deposit of $400 to hold your spot.
Final balance of payment is due August 11, 2000 otherwise you will forfeit your
deposit and your space will be automatically released.
I have also been informed of DAN insurance and am aware that my medical insurance may not
cover snorkeling or diving medical emergencies and medical evacuation. I understand that
my legal name on my plane ticket must match my passport. For countries not requiring
passports, legal name must match government issued birth certificate and driver's license
(except, women using married name must also bring marriage license). If names do not
match, I may be charged a fee or can be denied boarding and would be responsible for
any costs incurred.
I have been informed of the availability of trip insurance that would cover
certain conditions that may cause me to cancel/interrupt my trip. It is my
responsibility to check with my physician for any immunizations or medication
required or recommended. Also contact Central District Health.
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. If you need more information,
ESCORTS:
PHIL GRAF (Boise, ID)
BILL KNOBLAUCH (Sacramento, CA)
Omni Travel Adventures Group Trip
DIVERS $2,222 per person double occupancy
NON DIVERS $1,919 (with a Diving Buddy) per person double occupancy
Airfare from Boise - your cost may be different!
Cashiers Check due with balance on August 11, 2000
Cancellation subject to $400 cancellation fee per person
All prices are subject to change until paid in full. Mastercard/Visa is
accepted everything except the deposit
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 _______________________________________________________
I understand that the deposit of $400 is nonrefundable. Refunds will be made as follows:
0 to 60 days from departure or after departure - NO Refunds,
60 to 75 days from departure - 50% of the trip cost less the deposit and
more than 75 days from departure - the cost of the trip less the deposit. There is no refund
for any unused part of the tour/trip/meals/hotel/diving, etc. All prices including airfare are
subject to change until paid in full. I accept responsibility for any costs incurred by
airline schedule changes and any changes in taxes for air, hotel, meals or diving, etc.
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. _____
Payment Date ___________________
Amount: ___________ Credit Card MC/V ______________________________ Cash ___ Check No. _____
Trip Brochure ______________________________________________
Trip Insurance Brochure ____________________________________
DAN Insurance Brochure _____________________________________
please e-mail us at
omnidive@omnidivers.com.
Public Safety Diving Instruction
TDI/SDI Training Facility
EANx Technical Training Facility & Blending Station
DAN Business Member/Instructor Trainer
Ice Diving 2003
Klamath Falls OR
January 2003
Boise/McCall ID
February/March 2003
Fiji 2003
South Pacific
Other Trips
2002 - 2003
Ice Diving Photos
Cayman Photos
Dominica Photos
Fiji Photos
Omni Divers Underwater Services, L.L.C.
Omni Divers Underwater Services
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ODUS - Omni Divers - Omni Travel Adventures
This page was last updated on Fri Jul 28, 2000 11:00:00 PM-
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