Cozumel 2025 Trip Registration, Bluegrass Dive Club

Trip:

Trip Status:*

Original

Revision

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:*

Occupancy:*

Bed Type:*

Rooming with:

Smoking:

No

Yes

Are booking as a Diver?

Diver

Non-Diver

Do you want Nitrox?

Yes

No

Do you need rental gear?

Yes

No

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.

Guardian

The 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.

reCAPTCHA

Please 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.