2008 Qualification Reservation Form

A $255 deposit will be charged to your credit card to hold your place on the charter.

Deposit is forfeited if you cancel with less than 48 hours notice; otherwise we may apply the deposit to another weekend.

Charters run rain or shine.

Charters will only be canceled within an hour of departure.

Refunds are at the sole discretion of Capt Saam’s SCUBA School.

Fill out the information below and FAX to 203 487-0887

Date of charter(s) requested_________

Rental Gear Required?  Y___ N___

I will be performing qualification dives for [ __ ] Scuba Diver  [ __ ] Nitrox [ __ ] Rescue

[ __ ] Advanced [ __ ] Master Scuba Diver  [ __ ] Dive Leader [ __ ] Other ________________

First_______________________ MI_________ Last____________________________

Address_________________________________________________________________

City_________________________________ State________ Zip___________________

Amount $ 255.00 Card type: ___ Mater Card __ Visa  __ Amex __ Discover

Card Number

Expiration Date                                     I understand the refund policy as stated above.

                                                        Signature _______________________________________________________

Please note:

• All Departure Schedules are subject to change per the conditions.

• We will ONLY Cancel Charters based on current conditions at the time of departure.

• You must give more than 24 hours notice to postpone a charter.

• Failure to show up for a charter will result in loss of all charter & rental fees.