DiveAssure Member Registration Form
Apply for DiveAssure Membership Today! to Get the "DiveSafe" Insurance Profit
Please fill in the form and recheck your spelling before submitting the form.
Title
Mr.
Mrs.
Ms.
First Name
Last Name
Date of Birth
Address
Mobile No.
E-mail
Member Type
DiveSafe 1 Year (5,400 Baht)
DiveSafe 14 Day (3,600 Baht)
DiveSafe 7 Day (2,900 Baht)
Open Water Certification (Free until certified & within 180 days)
Start Date
Thank you for joining us.
