Divequest is a trading name of Birdquest Ltd
Destination(s) Resort(s)/Boat(s) No. of nights
 Holiday starting/ending dates
(dd/mm/yy)
Start: End:

Mr/Mrs/Ms/Miss
or other title		 Forename(s)
(in full, as in passport ) 		Surname
(Family Name)
1:
2:

Diving Qualification:
1:
2:
Address:
Telephone
(Home):
Telephone
(Work):
Email:
Do you want single occupancy?
Do you want us to arrange flights? If so give preferred departure airport, date of departure and return, preferred airline(s) etc:
Additional Requirements:

I/We enclose a cheque (made out to Divequest) for the total payment indicated below
Wish to pay the total payment indicated below by Visa or Mastercard (with 2% handling charge)
Have sent the total payment indicated below by bank transfer (Select as applicable)

Deposit Amount Due: £
Card Number:
Please use the tick box if you would prefer to phone us with your credit card details.
Expiry Date: (mm/yy)
Name as on card:



IMPORTANT INFORMATION
We need the following details in order to comply with local regulations or the requirements of
hotels, dive centres or liveaboard operators.
Date of Birth
(dd/mm/yy) 		Place of Birth Nationality Profession
1:
2:

Passport Number Place of Issue Date of Issue
(dd/mm/yy) 		Date of Expiry
(dd/mm/yy)
1:
2:

Contact name(s), address(es) and telephone number(s) in case of emergency during the
holiday:

Name(s) of Travel/Scuba Diving Insurance provider(s) and policy number(s), if known:

Special dietary requirements? Please indicate these here:

The deposit required is the total amount specified in the individual holiday description.
I/We have read the holiday description and the booking conditions in the Divequest brochure.
I/We accept these booking conditions in full.
I/We do not suffer from any disability which would prohibit full participation in the holiday.
*Signature(s): Date (dd/mm/yy):
*Please type your name if sending by email

Please send the completed form to:
DIVEQUEST, Two Jays, Kemple End, Stonyhurst, Clitheroe, Lancashire BB7 9QY, England, United Kingdom

OR