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2019 Dutch Springs Dive Expo

Attendee Registration

 

Attendee Registration

 

Dutch Springs Dive Expo
June 8, 2019

Day Demos: 8am to 4pm Saturday
Saturday Night Demos: 7:30pm to 9:30pm
Saturday Night Seminar: 7:30

~Demo Dive Gear from leading manufacturers in the Dive Industry~
~Participate in Seminars lead by Dive Industry Guru’s~
~This event kicks off dive safety seminar series~
~Prizes and More~

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Register by 5:00 pm Friday, May 24th, you will be sent your attendee badge in the mail. 
No need to visit us at the registration tent!

 

First Attendee's Name

First Name*

Middle Name

Last Name*

Phone*
First Attendee's Date of Birth*
I certify that I am 18 years of age or older
First Attendee's Information

Highest Certification Level (or Student if you are a student in a class)
First Attendee's Signature*
Second Attendee's Name

First Name*

Middle Name

Last Name*
Second Attendee's Date of Birth*
Second Attendee's Information

Highest Certification Level (or Student if you are a student in a class)
Third Attendee's Name

First Name*

Middle Name

Last Name*
Third Attendee's Date of Birth*
Third Attendee's Information

Highest Certification Level (or Student if you are a student in a class)
Fourth Attendee's Name

First Name*

Middle Name

Last Name*
Fourth Attendee's Date of Birth*
Fourth Attendee's Information

Highest Certification Level (or Student if you are a student in a class)
Fifth Attendee's Name

First Name*

Middle Name

Last Name*
Fifth Attendee's Date of Birth*
Fifth Attendee's Information

Highest Certification Level (or Student if you are a student in a class)
Sixth Attendee's Name

First Name*

Middle Name

Last Name*
Sixth Attendee's Date of Birth*
Sixth Attendee's Information

Highest Certification Level (or Student if you are a student in a class)
Seventh Attendee's Name

First Name*

Middle Name

Last Name*
Seventh Attendee's Date of Birth*
Seventh Attendee's Information

Highest Certification Level (or Student if you are a student in a class)
Eighth Attendee's Name

First Name*

Middle Name

Last Name*
Eighth Attendee's Date of Birth*
Eighth Attendee's Information

Highest Certification Level (or Student if you are a student in a class)
Ninth Attendee's Name

First Name*

Middle Name

Last Name*
Ninth Attendee's Date of Birth*
Ninth Attendee's Information

Highest Certification Level (or Student if you are a student in a class)
Tenth Attendee's Name

First Name*

Middle Name

Last Name*
Tenth Attendee's Date of Birth*
Tenth Attendee's Information

Highest Certification Level (or Student if you are a student in a class)
Attendee's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information and updates on the Dive Expo!
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Highest Certification Level (or Student if you are a student in a class)
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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