Register | Blue Marlin Dive Komodo

Full Name *

Your Email *

WhatsApp/Phone

Enter a contactable phone number if you do not have a WhatsApp number

Gender *

Nationality *

Country of Residence *

Passport Number *

Required for Komodo National Park Registration

KTP Number *

Zip/Pin/Postal Code *

Postal code of your home address

Date Of Birth *

Registration Location *

Hotel Booking Channel

Recreational Course *

Other Course *

Do you have travel Insurance? *

Yes

No

Please ask our staff for available insurance plans for daily and weekly diving if you do not have an insurance that covers diving!

Insurance Covers Diving? *

Insurance Provider *

Insurance Policy Number *

Certified Scuba Diver *

No

Yes

Certification Level *

Certification No

Optional

Certifying Agency *

Upload Certificate

Optional

Booking Channel (Diving) *

Direct

Partner/Agent

Agent Name *

Other Agent Name *

Emergency Contact Name *

Relationship with above *

Emergency Contact Phone *

Emergency Contact Email

Optional

How did you hear about us? *

Please tell us how you heard about us *