LONG POINT DIVERS

P.O. Box 1150, Port Dover, ON N0A 1N0       Tel: (519) 426-2590   Fax: (519) 426-8352

Email: lpdivers@xplornet.com        Website: http://www.longpointdivers.com/

Registration Form – Open Water Diver Course

May 26 & 27, 2012 – Simcoe Rec. Centre

Name (s): ______________________________________________________

Address: ______________________________________________________

______________________________________________________

Postal Code: ______________ Telephone: ________________________

Email Address: ________________________________________________

A $100.00 deposit per person is required to confirm your reservation and receive course materials
prior to the start of the class

Cheque/Money order enclosed (payable to Dixie Greenwood): $___________________

** *

Cancellation Policy:

Materials received prior to course are non-refundable.

Please mail completed form with your deposit to the address above.

 Thank you for registering !!