Download Printable Registration Form (PDF)
Diving For Life

Diving For Life 2010 Roatan Jamboree
REGISTRATION FORM


- October 2-9, 2010
- Anthony's Key Resort, Roatan
- Only one person per application
Step 1: Complete Registration Form online and submit.    
Step 2: Print the completed Form & Waiver (generated automatically), sign it, and mail WITH your deposit check. Credit cards CANNOT be used for the deposit. Unsigned forms or forms received without deposit checks will not be processed.
Step 3: Mail check (make check payable to Diving for Life - U.S. funds only) & copy of signed Registration Form to:
Anita Floyd - Diving For Life - 7816 SE 114th Ct - Portland, OR 97266
Please use REGULAR 1st CLASS MAIL; No Fed Ex, UPS or Airborne accepted
Participant Name
    First Name:    M.I.:    Last Name:

Mailing Address
    Street:    City:    State/Prov:    Zip/PC:    Country:

Contact Information
    Email:    Phone:    Cell:

Emergency Contact
    Contact Name:    Phone:     Relationship:


Diver Equipment (tanks, weights, belt included)
    I need to rent the following:
    Regulator/Gauges
    Computer
    BCD:     S    M    L    XL    XXL   
    Wetsuit: S    M    L    XL    XXL   
     I will need lbs of weight.

    I have all of my own equipment 		  LGBT Scuba Club Affiliation
Club affiliation determines where your share of the DFL charity distribution goes
VDC New York
OLSSC Dallas
Sea Squirts NC
Lambda DC
TRRR Toronto
SUBS Australia 		NCRD San Francisco
Ruby Red Flippers Portland
Bottom Dwellers Seattle
Triangle New England
GLUG London
SDRSC San Diego
Non-Affiliated


Accomodations - Includes room, meal package, transfer, tips, and diving (if applicable.) IMPORTANT: Please read room descriptions carefully BEFORE making your selection - Trip Info.

  Double Occupancies (per person) Divers (per person) Non-Divers (per person)
  • Hill or Dock Standard: Sold Out Sold Out
  • Hill Superior: Sold Out Sold Out
  • Key Standard: $1,034 $944
  • Key Superior: Sold Out Sold Out
 
  Triple Occupancies (per person - must identify two roommates) Divers (per person) Non-Divers (per person)
  • Key Standard: Sold Out Sold Out
  • Key Superior: Sold Out Sold Out
 
  Single Occupancy Divers (per person) Non-Divers (per person)
  • Hill or Dock Standard: Sold Out Sold Out

Total: - Deposit: * = Balance Due: ‡

* Minimum deposit of US $500 due via check or money order is payable to DIVING FOR LIFE. You may pay the full amount or any amount between $500 and the full amount if you desire. Please fill in your deposit amount above so that we figure your balance currectly. Balance due by June 15, 2010; also payable by check or money order (PREFERRED METHOD).

‡ Optional: BALANCE DUE may be paid by credit card with a 5% surcharge (Less Preferred Method).
I will be using Credit Card for Balance. Credit Card Balance Due:

Roomate Questionnaire
    I will be sharing a room with:

    If your roommate has not been selected, please answer the following to help us match you best:
    Gender Preference: female only     prefer female     male only     prefer male
    I am a: non-smoker     smoker     snorer     non-snorer
   

T-Shirt Size: Medium     Large     XL     2XL     3XL