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Ocean Love Event 活動報名表
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Fun Dive 潛水活動＆其他活動 - 請勿遲到喔！
俱樂部集合地點：新北市瑞芳區鼻頭路111-1號1F, 02 -24911119
參加活動日期 / Event Day
MM
/
DD
/
YYYY
2022 Ocean Love會員/Member
*
YES
NO
Fun Dive 上午潛水活動 平日9:30AM集合/週末7:30集合
Yes
No
Clear selection
Fun Dive 午夜潛活動 /16:30PM 集合 /需預約只限週六
Yes
No
Other:
Clear selection
Fun Dive 船潛活動 / 需預約/潛店活動為主
Yes
No
Clear selection
環保活動 / Cleaning Day Event/潛店活動為主
Yes
No
Other:
Clear selection
OWD新生 Fun Dive / Freshman Fun Dive
YES
NO
Clear selection
姓名/ Name
*
中文
Your answer
英文名/Passport Name
*
Your answer
國籍/ National
Your answer
民國出生年月日/Birthday
*
Your answer
西元出生年月日
Your answer
性別 / Gender
*
M
F
身分證字號 ID No.
*
保險專用/ Insurance Only
Your answer
Foreigner Passport Information / Insurance use only
Please send your passport copy to :
oceanlovetaiwan@gmail.com
外籍人士Foreigner use only /Passport No.
Your answer
聯絡地址/Address
*
Your answer
聯絡電話/Contact No.
*
Your answer
E-mail
*
Your answer
緊急聯絡人 & 電話 /Emergency Contact
*
Your answer
潛水C-card / 潛水人Only / Diving Certification
非會員請將潛水執照寄給我們 / Non member please email your certification to
oceanlovetaiwan@gmail.com
Your answer
潛水最高等級/ Diving Level
*
Your answer
潛水支數 / How many dives
*
Your answer
最後一次潛水時間 / Last time diving
*
Your answer
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