* First Name	* Last Name	MI	Nick (or Preferred) Name
Gender --Select-- Male Female	DOB(mm/dd/yy)	* Address
* City	* State	* ZIP	* Country
* Phone # Day	Phone # Evenings	* Email Address
Would you like to receive our quarterly newsletter advising you of specials and exciting news? Yes No

What travel documents are needed? Effective January 1, 2007, all travelers to the Bahamas need a passport. Check with the Bahamas Embassy for visa requirements if citizenship is not US.Click Here

* TRIP DATE mm/dd/yyyy (date of boarding)

How do you plan to travel to the Bahamas?

Plane Cruise / Ferry Info

* Arrival Carrier	* Flight #	* Arrival Airport	* Arrival Date	* Arrival Time
Departing Info
* Departing Carrier	* Flight #	* Departing Date	* Departing Time

Special Requests
Is this your 1st Blackbeard's Cruise? --Select-- Yes No
If not, when was your last Blackbeard's Cruise?
If not, how many previous Blackbeard's Cruises?
We highly recommend the purchase of travel insurance. This will protect you in case you have to cancel your trip due to unforeseen circumstances. You may obtain information about travel insurance from our office or our website. Click Here
Have you or do you plan to purchase travel insurance? --Select-- Yes No
Diving Information

* Are you a certified diver? --Select-- Yes No	* # of Dives?	* Salt Water	* Fresh Water
I rate my skill as a scuba diver: --Select-- Beginner Intermediate Advanced nondiver	Certifying Agency	Level	Certification Number

Rental Requests

Regulator Dive Computer Dive Light BC Size

Wetsuit:Full Shorty Size

If renting a BC or Wet Suit: height weight

All rentals must be paid for inadvance, please contact the office to make these arrangements.

* Medical Information
Required medication Medication which may not be given Medical Alert Information
* Diver's Insurance Company & policy number		* Contact in case of emergency

* Relation

* Day Phone#

* Evening Phone#

In case of a medical emergency, I authorize the crew of the vessel to administer first aid or get proper medical attention if necessary. I understand that the nearest recompression chamber is hours away and may require air evacuation. The time involved with boat and air transport poses additional risk to my personal safety. I accept this risk and am fully prepared to pay all expenses related to evacuation and treatment should it be deemed necessary by the vessel or myself.