Registration Form
  Jumper Pre-Registration $45 (until Jan. 9, 2010)
Jumper Registration Fee: $55.00
Non-jumper Pre-Registration Fee: $15.00 (until Jan. 9, 2010)
Non-jumper Registration Fee: $25.00
Participant Name:
First Name Initial Last Name
                   
USPA License# (or equivalent)
E-mail Address:
Telephone Number:   Ext:
Fax Number:
Address:
City:
State:  or  Province:
Zip/Postal Code:     Country:

Registration and Deposit Options

( Please make sure the appropriate check box are checked )

Jumper Pre-Registration $45 (until Jan. 9, 2010)

Jumper Registration Fee: $55.00

Amount of People:

 

Payment Information:
 ( U.S. Funds only )

Visa    Master Card      Money Order
Total Amount Paid:
Card Number:
Expiration Date: ( Month/Year )
Card Holder Name:

(If paying by money order)

Make Payable to Xtreme Divers Inc.

Send Money Order & Registration Form to:


Castillo del Mar 1316

4633 Isla Verde Ave

Carolina, PR 00979

 

Comments or Questions

By sending the registration you are agreeing to our terms and conditions.