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Guest Registration
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Guest Registration
This registration will take approximately 5 mins to complete.
Kindly provide the necessary information to enable us to prepare for you arrival. All information collected will be kept private for the sole purpose of preparing for your arrival to Gaia Love. No personal information will be disseminated for any other purpose besides the one mentioned above.
Trip Date
Trip ID
Name (As In Passport)
*
First
Last
Date of Birth
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day
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January
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month
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2022
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1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
year
Nationality
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Congo (Brazzaville)
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wales
Yemen
Zambia
Zimbabwe
Country of Residence
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Congo (Brazzaville)
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wales
Yemen
Zambia
Zimbabwe
Email
Phone
Passport Number
Date of Expiry
A passport copy is required for port clearance. Please ensure your passport has at least 6 months of validity before travel dates. It is also imperative to ensure you have the necessary visas to enter Indonesia.
Upload a Passport File
Upload your signed liability release here. File size should be kept to less than 1mb.
Upload Signed Liability Release
Vaccination Status
1 Vaccine
2 Vaccine
2 Vaccine + 1 Booster
2 Vaccine + >1 Booster
Raja Ampat Permit No. (if you already have a valid National Park Permit)
Arrival From
Arrival Flight Number
Arrival Date
Arrival Time (24hrs)
HH
:
MM
Pre Cruise Hotel (If you arriving earlier and require your pick-up at an alternate lodging instead of the airport, please let us know by filling up the pre-cruise field in the form.)
Departure To
Departure Flight Number
Departure Date
Departure Time (24hrs)
HH
:
MM
Post Cruise Hotel (If you are going to an alternative lodging after your trip instead of the airport, please let us know by filling up the post-cruise field in this form.)
Emergency Contact Person
First
Last
Emergency Contact No.
Relationship
Dive Insurer
Insurer Contact
It is mandatory to have a valid dive insurance on every voyage on board GAIA LOVE. Providing your insurance company contact information is vital in reducing reaction time for assistance in the event of an emergency.
Policy No.
Policy Expiry Date
First dive trip to Indonesia?
Yes
No
Have you dived in strong currents before?
Yes
No
Are you Nitrox certified?
Yes
No
Will you required Nitrox for this trip?
Yes
No
Will you be using a camera on this trip?
Yes
No
Any special food request? (may need a minimum 45 days or more to fulfill)
Any allergies we should be aware of?
Certification Agency
PADI
SSI
NAUI
SDI/TDI
other
Diver Certification
Open Water
Adv Open Water
Rescue Diver
Master Scuba
Divemaster
Instructor
other
No. of Logged Dives
Last Logged Dive
Do you need to rent any dive gear from us? * Rental fees applies. **Limited sets subject to availability. Please provide sizing, height and weight.
None needed
BCD (*size is required)
Regulator
Wetsuit (*size is required)
Full Foot Fins (*size is required)
Mask
Dive Torch
Dive Computer
other
Height
Weight
Sizing (*required if rental gear is needed)
XS
S
M
L
XL
BCD
Wetsuit
Full Foot Fin Size ( Pls indicate size in EU, if you need rental fins)
Thank you for registering. We look forward to having you on board GAIA LOVE.
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