MIKE POTTS DIVING at DIVERS DOWN SWANAGE.

 BOOKING FORM

 

Name:

 

 

Address:

 

 

 

 

Email:

(Please write clearly)

Tel:                                                 Mobile:

 

 

Emergency contact number:    

(Please use a number which could be used during your course.)

 

Course required:

 

 

Course start Date:

 

Cost:

 


(Balance due on day 1 of your course.)

 

Deposit:

 

(Non refundable as materials will be sent to you at this stage.)

 

 

I would like to book with Mike Potts Diving at Divers Down Swanage as indicated
above, I have reviewed the Medical Statement, Safe Diving Practices,
Liability Release and Assumption of Risk forms and I agree to their conditions:

 

Signed: _____________________________________________________________________

                                                                    `           

NB: A booking form can only be accepted if this form is completed and signed.

Thank you for booking with Mike Potts Diving at Divers Down Swanage.

 

Please return this form to:

 

Mike Potts. The Pier, High Street, Swanage. BH19 2AR.

  Telephone 07968 780198   e-mail: mike@pottsdiving.co.uk     
www.mikepottsdiving.co.uk