Make your Reservations to Dive TODAY!
Reservations will go through Eugene Skin Divers Supply. Price does not include equipment. Equipment rental may be reserved through ESDS, or your local professional dive store. Due to the limited number of participants allowed in a session, your date selection is not guaranteed until payment is made.

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Available Dates:
Program preference:

*First Name:
*Last Name:

*Mailing Address:

*City, State & Zip:



Will you be diving with a Buddy? What is their name?

*Name of Emergency Contact / Relationship:

*Emergency Contact Phone number / alt.:

*Physician's Name / Phone:

*SCUBA Certification Agency:

*SCUBA Certification Level:

*Number of dives in past 12 months:

*Number of cold water dives:

*Date of last dive:

*Will you be diving in a drysuit?:
*If yes, how many dives have you done in a drysuit?:

*How is your buoyancy control?:

*Type of regulator used?: yoke or DIN:

*Air Consumption:

*How did you Hear about the program:

*What Dive Store do you frequent

Notes: Date(s) preferred, please list: