HOT Sailing - шаблон joomla Продвижение

Hotline :  +62 811 8744 422  
Email : info@maipadeapati.com

 

Welcome aboard! Enjoy the Cruise!

KLM Maipa Deapati liveaboard will take you sail around the Komodo National Park, Banda Sea, Ambon, Alor, Maumere, Raja Ampat, Wakatobi, Takabonerate and other area
Pleasure relax with hoping island and snorkeling, or diving explore the underwater beauty of Indonesia.

 

For Diver, please fill out the form below :

TRIP INFORMATION

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Length of Trip / Package :*
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PERSONAL INFORMATION

Full Name :*
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Passport / ID Number :*
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Country / Nationality :*
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Phone :*
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Email :*
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Passport / ID Card (file max. 2 Mb)*
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Scuba Diving Certification :*
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Other Scuba Diving Certification :*
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Level / Qualification :*
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Number of Dives / Dive Logs :*
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Date of Last Dive :*
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Diving Certification Card (file max. 2 Mb) :*
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EQUIPMENT RENTAL

Scuba Equipment :*
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Equipment :*




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BCD Size :*
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Wetsuite Size :*
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Fin Size :*
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INSURANCE

Diving Insurance :*
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DAN Short Term Program :*
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Name of company :*
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Policy Insurance No :*
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Contact Telephone No :*
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MEDICAL INFORMATION

Blood Type :*
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Body Size :*
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Allergies :*
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Specific Medical Conditions / Meals :
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Emergency Contact :*
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Name :*
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Phone :*
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TRANSFER IN / OUT

Pick-up Point :*
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Flight Number | Time :*
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Hotel Name | Time :*
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Drop-off Point :*
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Flight Number | Time :*
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Hotel Name | Time :*
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Message / Notes :
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Terms & Conditions :*
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For Non-Diver, please fill out the form below :

TRIP INFORMATION

Trip / Package Type :*
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Vessel / Boat Name :*
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Hotel / Resort Name :*
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Destination :*
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Date of Departure :*
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Length of Trip / Package :*
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PERSONAL INFORMATION

Full Name :*
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Passport / ID Number :*
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Date of Birth :*
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Country / Nationality :*
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Phone :*
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Email :*
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Passport / ID Card (file max. 1 Mb) :
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SNORKELING EQUIPMENT

Equipment :*


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Fin Size :*
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Body Size :*
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MEDICAL INFORMATION

Travel Insurance :*
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Name of company :*
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Policy Insurance No :*
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Contact Telephone No :*
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Blood Type :
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Allergies :*
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Specific Medical Conditions / Meals :
Invalid Input
Emergency Contact :*
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Name :*
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Phone :*
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TRANSFER IN / OUT

Pick-up Point :*
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Flight Number | Time :*
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Hotel Name | Time :*
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Drop-off Point :*
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Flight Number | Time :*
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Hotel Name | Time :*
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Message / Notes :
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Privacy Policy - Terms & Conditions :*
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(*)required

 

     
     
Sales & Marketing Office   Connect with Us.!
     
Business Center MSA-201 Metropolis Apartment
Jl. Raya Tenggilis No.127 Surabaya
Jawa Timur - Indonesia 60292
Phone   +62 31 8477484
Hotline   +62 811 8744 422
E-Mail    info@maipadeapati.com
       
                 
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