TAT License No. 12/01654
Scuba Diving Trip Application Form
- 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.

Personal Information

Name (Thai) Nickname *
Name (Eng.) Birth Date
Weight kg Heightcm Shoe size Gender *
(Shoe size may be specified in UK or US size)
Tel. Fax Mobile
Address Citizen ID. *
City/Province ZIP Code Best contact
E-mail * E-mail 2

Health Information

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

Diving Information

Last Cert. Experiencedives Last time on
Equipment
Size BCD Wetsuit Fins
Other things you want us to know