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

April 24 & 25, 2010 – Simcoe Rec. Centre

Name (s): ______________________________________________________

Address: ______________________________________________________

______________________________________________________

Postal Code: ______________ Telephone: ________________________

Email Address: ________________________________________________

A $75.00 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 Long Point Divers): $___________________

** Registration deadline: April 12, 2010 **

Cancellation Policy:

Materials received prior to course are non-refundable.
Notice of cancellation must be received 10 days prior to start of class to receive refund.

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

 Thank you for registering !!