Please fill in our guest Profile Form below and submit prior to your expedition.
This Form is Information required by Undersea Explorer to assist in planning your holiday.

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Personal Details :
Trip Date:	to
Trip Ref Number:
Your Name:
Email Address:
Address:
City:
State:
Zip/Post Code:
Country:
Phone:
Fax:
Date of Birth:
Sex:	Male Female
Emergency Contact:
Relationship:
Address:
Phone:

 

All passengers on Undersea Explorer are automatically placed onto our database to receive updated news and specials. If you do not want to be on our database please check  the box.		No thanks
How did you find out about the "Undersea Explorer" ?		Fellow Diver Internet Travel Agent Dive Shop Repeat Client Magazine Advertisement Other Publication Dive Travel Exhibition Scientific Body
Do you have any special dietary requirements ? (Allergies, Vegetarian, etc)
For passengers travelling on Far Northern Expeditions only:
For Charter Flight requirements: Body Weight
Luggage Weight including Dive Gear
Please note 35 Kilos per person luggage restrictions for charter flight
Snorkelling and Diving Information
Level of Experience:		Beginner Intermediate Experienced
Certification Agency:
Certification Level
Certification Number:
Total Number of Dives
Date of Last Dive
Refresher Course  Required - $55
PADI Advanced Course Required - $200
PADI Nitrox Course Required - $200 Note: Qld regulations state that nitrox course participants must be certified and have a min of 20 logged dives.
Gear Hire
Queensland Dive Regulations requires the following equipment be used while Scuba Diving Regulator and alternate air source Buoyancy control device and power inflator Depth Gauge, Time Keeper, Submersible Pressure Gauge Mask, Fins, Snorkel, Log Book A Dive Computer is Compulsory on the Undersea Explorer Hire of dive gear and dive courses are payable onboard the vessel
Wetsuit ($35.00/week):		Not required SML MED L XL XXL XXXL
B.C.D. ($70.00/week):		Not required SML MED L XL XXL XXXL
Regulator & computer ($100.00/week):
Mask/Fins/Snorkel ($35.00/week):		Foot size:
Computer only ($50.00/week):
Full gear hire ($200.00/week):   Excluding Flashlight		Not required SML MED L XL XXL XXXL
Flashlight ($45.00/week):
Other Information
Do you have any Medical Conditions that we should know about (Allergies/History, etc) ?
If you have a medical condition, we require a letter from your Doctor stating that you are fit to scuba dive with your condition.
Do you have any other special requirements ?
Environment Management Charge
The Great Barrier Reef Marine Park Authority collects an Environmental Management Charge (EMC) of $15.00per person for all passenger visiting the Great Barrier Reef who are provided with a service in the Marine Park under a tourist program. The total of $15.00 per person for the EMC is payable on board the Undersea Explorer.
Emergency Medical Evacuation Insurance
All monetary amounts are expressed in Australian Dollars . Convert Currency The Undersea Explorer is a Divers Alert Network (DAN) Sponsor offering TravelAssist emergency evacuation for our guests. International guests are eligible to take out 30 day membership. Australian citizens do not qualify for the 30 day policy, however we recommend you take out a yearly Membership. Please advise if you require this Insurance and the application form will be forwarded to you. Dan TravelAssist Information Please Note If you are resident outside the Asia/Pacific region and require yearly membership, you must join in the Country of your residence.
Require 30 day DAN Travel Assist:		Yes No
Require Yearly Membership		Yes No
I already have Travel Insurance Cover (please advise below)
Name of Insurance Organization       Membership Number / Reference     Contact Phone Number on Policy
Comments Anything extra we have not considered

Operators of the UNDERSEA EXPLORER reserve the right to use another vessel of similar standard and to cancel or alter the itinerary or part thereof due to mechanical problems, unfavourable weather or any delay due to same.

We highly recommend Travel Insurance to allow for unforeseen circumstances.

To submit this form, please enter the NUMBERS OR CAPITALS above

Your next step is to indicate your intention to sign
the Undersea Explorer's Liability Release Form

info@undersea.com.au