Customer+Information+Card

							Customer Information/Record Card

Name: __________________________________________________        Course & Start Date: _______________________________________________

Date of Birth: ____________________________________________     Shoe Size: ______________ BCD Size: X-Small/Junior ___ Small ___Med ___

Address: ________________________________________________       BCD Size: Large ___ X-Large ___

________________________________________________________        Interested in Diving trips: Maldives: ___ Lanzarote: ___ Bali: ___ Oman: _____

Mobile/Other Phone Number: ______________________________       Egypt: ____ Any other Suggestions: __________________________________

Email address: ___________________________________________      Any other relevant information: ____________________________________

Allergies/Medical Conditions: _______________________________   * Would all participants -please email a head & shoulders photograph for our

________________________________________________________        records – email to info@just-dive.co.uk - Many thanks!

Emergency Contact Information: ____________________________     ________________________________________________________




 If you’re interested in any further courses – such as Open Water Diver or Advanced, or even a scuba
          Refresher – just drop me a line at info@just-dive.co.uk and I’ll get back to you ASAP!