CURACAO NETHERLANDS ANTILLES

Payment Schedule as of June 2, 1999.
A $400 nonrefundable deposit is due with this application! Additional $400 due July 1, 1999. Additional $400 due July 15, 1999. Final balance of payment is due August 1, 1999 otherwise you will forfeit your deposit and your space will be automatically released. All prices are subject to change until paid in full. Monthly payments are available. Mastercard/Visa is accepted for airline fare only. Each Traveler Must Complete the Following:

Legal Name _______________________ Birthdate ______ U.S. Citizen? YES NO

Address _______________________________________________________________

Telephone Home _____________Telephone Work ____________ FAX ____________

Rooming With _____________ Passport Number ___________ Expiration ______

Are you a certified diver? YES NO Certification Agency and Number ______________

Number of Dives ____ Number of Dives in the past year _____ Date of Last Dive ____

DAN Insurance Required! or similar diver accident insurance coverage! YES NO

DAN Insurance Number ________ Would you like to arrange monthly payments? YES NO

Emergency Contact Not Traveling With You:

Name ____________________ Relationship ________ Telephone _____________

I understand that the deposit of $400 is nonrefundable. Refunds will be made as follows: 0 to 60 days from departure or after departure - NO Refunds, 60 to 75 days from departure - 50% of the trip cost less the deposit and more than 75 days from departure - the cost of the trip less the deposit. There is no refund for any unused part of the tour/trip/meals/hotel/diving, etc. All prices including airfare are subject to change until paid in full. I accept responsibility for any costs incurred by airline schedule changes and any changes in taxes for air, hotel, meals or diving, etc.

I have also been informed of DAN insurance and am aware that my medical insurance may not cover snorkeling or diving medical emergencies and medical evacuation. I understand that my legal name on my plane ticket must match my passport. For countries not requiring passports, legal name must match government issued birth certificate and driver's license (except, women using married name must also bring marriage license). If names do not match, I may be charged a fee or can be denied boarding and would be responsible for any costs incurred.

I have been informed of the availability of trip insurance that would cover certain conditions that may cause me to cancel/interrupt my trip. It is my responsibility to check with my physician for any immunizations or medication required or recommended. Also contact Central District Health.

Omni Divers Underwater Services, L.L.C. and Omni Travel Adventures arranges for your travel services with reputable hotel, airline and other independent suppliers who provide the service you purchase. However, Omni Divers Underwater Services, L.L.C. and Omni Travel Adventures does not have direct control over them; therefore Omni Divers Underwater Services, L.L.C. and Omni Travel Adventures, its directors, agents and employees assume no responsibility or liability for the weather, services, transportation or equipment made available or as to its safety, quality or condition, nor for acts of any employee or agent of any establishment, firm, person or entity furnishing such service, transportation or equipment. Nor does Omni Divers Underwater Services, L.L.C. and Omni Travel Adventures, its directors, agents and employees assume any responsibility or liability for the safety of any participating client engaged in water activities above or below the water. We are committed to your satisfaction and thank you for your business and cooperation.

Signature ____________________________________ Date _____________________

Deposit Date _______ Amount: _____ Credit Card MC/V ___ Cash ___ Check No. ___

Payment Date _______ Amount: _____ Credit Card MC/V ___ Cash ___ Check No. ___

Payment Date _______ Amount: _____ Credit Card MC/V ___ Cash ___ Check No. ___

Payment Date _______ Amount: _____ Credit Card MC/V ___ Cash ___ Check No. ___

Trip Brochure _______ Trip Insurance Brochure _____ DAN Insurance Brochure ___

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