Belize Liveaboard 2021 Trip Sign-up Belize Liveaboard 2021 Trip Sign Up Please submit ONE form for each individual traveler.If changes are required, please submit a NEW form andcheck the Revision block below.If you are attempting to cancel an existing reservation - go back to the Trip Page and select the Cancel form. Trip:Belize Liveaboard 2021 Trip Status:*OriginalRevision Name:*Passport is required. Please enter your passport information below: Passport Number: Home Address: Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Best Phone #: (Include Area Code) Email:As Shown On Passport Expiration Date:You are responsible for providing the proper travel identification documents to board the airline and/or to enter the country and reenter the US. Room Type:Select Room RequirementsDeluxe Stateroom #4-10 (at package price)Master Stateroom #2 & #3 ($$ upcharge, if available)Deluxe Stateroom #1 ($$ upcharge, if available) Bed Type:Select Bed Type1 Twin Bed1 King Bed (combined twins, if both guests agree) Rooming with: Are booking as a Diver?DiverNon-Diver Do you want Nitrox?YesNo Do you need rental gear?YesNo Comments or Additional Information: Emergency Contact Name: EContact's Phone #: EContact's Address: Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Relationship:Include Area Code By checking this box, I acknowledge that I have read and agree to the terms of the Bluegrass Dive Club's Waiver and Release of Liability Form. *Yes Initials (substitute signature) of person named in this reservation:*If the applicant named on this form is under the age of 18, this form will not be valid unless submitted by a Parent or someone assuming guardianship responsibility for applicant. Please enter name of Parent/Guardian submitting this form. GuardianThe Bluegrass Dive Club does not require but recommends you secure a "Child Care Authorization" document for any non-custodial person under the age of 18 you plan to bring. Click ==> HERE for a PDF copy of this form.Submit ReservationReset Form reCAPTCHAPlease be patient - Form may take a short time to process - You will see a confirmation page when complete. You will receive a confirmation of your submitted reservation at the email address given above for your records.