- The box with * is required. Please fill them all.
- You may not fill "Name (Thai)" if you do not have one.
- Please use the address that we can contact or post documents to you, not necessary to be legal residence.
- In case you are not living in Thailand, please note your city in the box "Other things ..." at the bottom.
- You can easily move to the next box with the button [Tab] on your keyboard.

Name (Thai)	นายนางน.ส.ด.ช.ด.ญ.			Nickname	*
Name (Eng.)	Mr.Ms.Mrs.Miss			Birth Date
Weight	kg Heightcm Shoe size			Gender	MaleFemale*
	(Shoe size may be specified in UK or US size)
Tel.		Fax		Mobile
Address				Passport No.
City/Province	== Not in Thailand ==KrabiBangkokKarnjanaburiKalasinKamphangpetchKhonkaenChanthaburiChachoengsaoCholburiChainartChaiyaphumChumphonTrangTradTakNakhon nayokNakhon pathomNakhon phanomNakhon ratchasimaNakhon sri thammaratNakhon sawanNonthaburiNarathiwasNanBuriramPathumthaniPrachuabkirikhanPrajinburiPattaniPhranakhon sri ayuddhayaPhayaoPhang-ngaPhatthalungPijitPhitsanulokPhuketMahasarakhamMukdahanYalaYasothornRanongRayongRatchaburiRoi-edLopburiLampangLamphoonSrisaketSakolnakhonSongkhlaSatoonSamutprakarnSamutsongkhramSamutsakhonSaraburiSinghburiSuphanburiSurat-thaniSurinSukhothaiNongkhaiUdonthaniUtaraditUthaithaniUbolratchathaniAngthongChiangraiChiangmaiPetchaburiPetchaboonLoeiPhraeMaehongsonZIP Code			Best contact	E-mailMobileSMSHome Phone
E-mail	* E-mail 2

Dietary Spec.	(e.g. Not spicy)	Drug Allergy
Congenital Disease		Blood Type
Emergency Contact		Relationship
Address		Tel./Mobile
Personal Hospital		Tel.

Last Cert.	Non-DiverOpen WaterAdvanced Open WaterRescueMaster Scuba DiverDivemaster TraineeDivemasterOWSI Experiencedives	Last time on
Equipment	Mask Snorkel Fins Wetsuit BCD Regulator Dive Comp.
Size	BCD Wetsuit Fins2 - 33 - 43½ - 4½4 - 55 - 66½ - 7½8 - 99½ - 10½11 - 12