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Scuba Duba Doo Dive Center
Jl. Legian Kelod, Gg Melani 3B
Kuta, Bali 80361 Indonesia
Phone & Fax: (+62 361) 750 724
After Hours: +62 81 2388 6881 or +62 81 855 6276

Below is a list of questions. Please fill out any information you know. If do not remember or do not know, you can just leave it blank. The only required field is your name and email address. This is so we can reply back to you. We will not give your email address out to any other parties, and all information you enter below is strictly confidential!

WHAT ARE YOU INTERESTED IN?

Areas of interest
Are you certified diver ?	YES NO
What is your certification level ?
When was the last time you dived ?
Where was this ?
What is your arrival date in Bali ?
Where will you stay (if you know) ?
Would you like us to organize your hotel accommodations ?	YES NO
What is your price range for a hotel ?
What are the dates & locations you would like to go diving ?
What is your preferred language ?
Are there any activities we can arrange for you while you are here in Bali ? (e.g. Hotel, Rental Car (with or without driver), trekking, white water rafting, Parasailing, Cultural activities, etc)
Please let us know where you heard about us

PERSONAL INFORMATION

Name (required)
Address
City
Prov/State
Postal Code
Country
Phone
Fax
Email Address (required)
Do you have any health issues ?
Request/Comments YOUR EMAIL-ADDRESS IS REQUIRED

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Safety

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