HOT Sailing - шаблон joomla Продвижение

Hotline : +62 811 9439 541  
+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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PERSONAL INFORMATION

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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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Policy Insurance No :*
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MEDICAL INFORMATION

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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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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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Message / Notes :
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Terms & Conditions :*
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For Non-Diver, please fill out the form below :

TRIP INFORMATION

Destination :*
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Date of Arrival :*
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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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MEDICAL INFORMATION

Blood Type :*
Invalid Input
Allergies :*
Invalid Input
Specific Medical Conditions / Meals :
Invalid Input
Emergency Contact :*
Invalid Input
Name :*
Invalid Input
Phone :*
Invalid Input

TRANSFER IN / OUT

Pick-up Point :*
Invalid Input
Flight Number | Time :*
Invalid Input
Hotel Name | Time :*
Invalid Input
Drop-off Point :*
Invalid Input
Flight Number | Time :*
Invalid Input
Hotel Name | Time :*
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Message / Notes :
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Terms & Conditions :*
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Captcha :* Captcha :
  Refresh
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(*)required

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Sales & Marketing Office

  Jl. Raya Manyar No. 95B
Menur Pumpungan, Sukolilo
Surabaya - Indonesia 60284
  Phone   +62 31 8477484
  Hotline   +62 811 9439 541
+62 811 8744 422
  E-Mail    info@maipadeapati.com

 

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