Freediving Course Registration Form

Freediving Course Registration Form

Please fill in the form below.
Pool Course in Jan

16-17 Jan 23-24 Jan 30-31 Jan Private Session, Please suggest date
*Pool Course Fee is RM750.

*For date 16-17 and 30-31 additional fee RM50 will apply for extra pool fee price at Bukit Kiara Equestrian Club
Full Name *

Prefix First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
Do you have SSI ID? if yes please enter your number
Date of Birth *

Month Day Year
Gender

Male Female
Shoe Size ( for your Fins) in Eu
Should be Empty: