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License Course Booking Form

Course Name
Preferred Participation Date(Required)

* Please note that confirming availability and processing payment may require some time, so reservations on very short notice may not be accepted.

Number of Participants

*For groups of 8 or more, please enter the information of participants beyond the 8th person in the remarks field.

Dive Guide

Pick-up Location
Drop-off Location
Flight Information
Arrival Date in Phuket
Arrival Flight / Time
Departure Date from Phuket
Departure Flight / Time

* If undecided, please provide details later.

Payment Method

● Customer Information

Representative(Required)
Full Name
Last
First
Date of Birth(Required)
Gender
Address(Required)
Country of Residence
Postal Code
State / Prefecture
City / Ward
Street Address
Building / Apartment
Contact Information(Required)
Phone Number
Email
Participant Information 1(Required)
Full Name
Last
First

* Participant 1 should be the same as the representative's name.

Nationality
Age
years old
Gender
Certification Agency
Certification Level


Number of Dives
dives
Last Dive
Rental Equipment

*A dive computer is required.


Size
Height cm
Weight kg
Foot cm
Participant Information 2
Full Name
Last
First
Nationality
Age
years old
Gender
Certification Agency
Certification Level


Number of Dives
dives
Last Dive
Rental Equipment

*A dive computer is required.


Size
Height cm
Weight kg
Foot cm
Participant Information 3
Full Name
Last
First
Nationality
Age
years old
Gender
Certification Agency
Certification Level


Number of Dives
dives
Last Dive
Rental Equipment

*A dive computer is required.


Size
Height cm
Weight kg
Foot cm
Participant Information 4
Full Name
Last
First
Nationality
Age
years old
Gender
Certification Agency
Certification Level


Number of Dives
dives
Last Dive
Rental Equipment

*A dive computer is required.


Size
Height cm
Weight kg
Foot cm
Participant Information 5
Full Name
Last
First
Nationality
Age
years old
Gender
Certification Agency
Certification Level


Number of Dives
dives
Last Dive
Rental Equipment

*A dive computer is required.


Size
Height cm
Weight kg
Foot cm
Participant Information 6
Full Name
Last
First
Nationality
Age
years old
Gender
Certification Agency
Certification Level


Number of Dives
dives
Last Dive
Rental Equipment

*A dive computer is required.


Size
Height cm
Weight kg
Foot cm
Participant Information 7
Full Name
Last
First
Nationality
Age
years old
Gender
Certification Agency
Certification Level


Number of Dives
dives
Last Dive
Rental Equipment

*A dive computer is required.


Size
Height cm
Weight kg
Foot cm
Remarks

Booking by Email

If your booking details are complex, you can bypass this form and apply directly via email.

Book by Email

When booking via email, please also provide the following information:

  • Full name and gender of the representative
  • Contact phone number
  • Accommodation details in Phuket
  • Arrival and departure dates in Phuket
  • Flight numbers and times

Booking Details

Course Name
Preferred Date(Required)
Number of Participants
Adults
Dive Guide
Pick-up Location
Drop-off Location
Flight Information
Arrival Date in Phuket
Arrival Flight / Time
 
Departure Date from Phuket
Departure Flight / Time
 
Payment Method

Customer Information

Representative(Required)
Full Name (Roman letters)
Date of Birth(Required)
Gender
Address(Required)
#
Contact Information(Required)
Phone Number
Email

Participant Information

Participant 1(Required)
Full Name (Roman letters)
Nationality
Age
years
Gender
Diving Organization
Certification Level
Number of Dives
dives
Last Dive
Rental Equipment
Body Size
Height cm / Weight kg / Foot cm
Participant 2
Full Name (Roman letters)
Nationality
Age
years
Gender
Diving Organization
Certification Level
Number of Dives
dives
Last Dive
Rental Equipment
Body Size
Height cm / Weight kg / Foot cm
Participant 3
Full Name (Roman letters)
Nationality
Age
years
Gender
Diving Organization
Certification Level
Number of Dives
dives
Last Dive
Rental Equipment
Body Size
Height cm / Weight kg / Foot cm
Participant 4
Full Name (Roman letters)
Nationality
Age
years
Gender
Diving Organization
Certification Level
Number of Dives
dives
Last Dive
Rental Equipment
Body Size
Height cm / Weight kg / Foot cm
Participant 5
Full Name (Roman letters)
Nationality
Age
years
Gender
Diving Organization
Certification Level
Number of Dives
dives
Last Dive
Rental Equipment
Body Size
Height cm / Weight kg / Foot cm
Participant 6
Full Name (Roman letters)
Nationality
Age
years
Gender
Diving Organization
Certification Level
Number of Dives
dives
Last Dive
Rental Equipment
Body Size
Height cm / Weight kg / Foot cm
Participant 7
Full Name (Roman letters)
Nationality
Age
years
Gender
Diving Organization
Certification Level
Number of Dives
dives
Last Dive
Rental Equipment
Body Size
Height cm / Weight kg / Foot cm

Remarks

Cancellation Policy

Contact for Cancellation
If you need to cancel your reservation, please make sure to notify us via the following email address.

Cancellation Email: info@houbou-ya-phuket.com

Cancellation Terms
If you cancel your reservation, cancellation fees will apply according to the conditions below. Please note that the cancellation policy may vary depending on the cruise you are using.

Cancellation Conditions: Diving License Course

Up to 8 days before departure
Free of charge
Within 7 to 1 days before departure
50% of the tour fee
After 17:00, 1 day before departure
100% of the tour fee

Please review the Terms of Use and Cancellation Policy again. If you agree, check the option and press the "Submit Booking Form" button.

Check Terms of Use

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E-TRAVEL INFORMATION CO.,LTD.
135/31 Moo 4, Patak Villa Soi 1.,T.Rawai, A.Muang, Phuket 83130 TEL:+66-81-088-2031