Aquanauts Complete Internship
Enrollment & Deposit Payment Form

Personal Information

Country Code

Telephone Number

(Select a Country) United Kingdom United States of America Thailand --------------- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocoa (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote Divoire Croatia (local name: Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada >Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary India Iceland Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic Peoples Republic of Korea, Republic of Kuwait Kyrgyzstan Lao Peoples Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallisw and Futuna Islands Western Sahara Yeman Yugoslavia Zaire Zambia Zimbabwe Not Listed

Male    Female

Married Not Married

What is your current scuba diving certification?

(Select One) NOT CERTIFIED (Non-Diver) ---------- PADI ---------- Open Water Diver Advanced Open Water Diver Rescue Diver Master Scuba Diver Divemaster ---------- BSAC ---------- Ocean/Club Diver Sport Diver Dive Leader Advanced Diver ---------- CMAS ---------- 1-Star Diver 2-Star Diver 3-Star Diver ---------- SSI ---------- SSI Open Water SSI Advanced Open Water Stress & Rescue Techniques Master Diver Dive Con ---------- SAA ---------- Club Diver Dive Leader Dive Supervisor

Shoe Size

UK US Europe

Height and Weight (for equipment sizing)

Height Weight

Internship Reservation Information

Start Date

How soon would you like to begin your internship?

(Select One) 1 Week or Less 1-2 Weeks 2-4 Weeks 4-6 Weeks 1-2 Months 2-3 Months 3-4 Months 4-5 Months 6 Months to 1 Year More than 1 Year

Internships & Traineeships

Which Aquanauts Instructor Training Internship(s) or Traineeship(s) are you interested in?

Complete Divemaster
Complete Instructor
PERT Professional (PADI Instructor)
PERT Standard (PADI Divemaster)

Master Scuba Diver Trainer (MSDT) - Improve your job prospects!
IDC Staff Instructor - Get certified to teach instructors
Master Scuba Diver - Non-Professional Traineeship
Technical Diving (Introductory)
Technical Diving (Intermediate)
Technical Diving (Advanced)
PERT Basic (Standalone)

Equipment Package and Gear Your Currently Own

Do you require equipment? (If you have some already, check the boses at right.)

Choose One

I Want the standard equipment package.

No Thanks!. I have al my own gear.

Which, if any, of the following pieces of dive equipment do you already own?

BCD
Regulator + Alternate Air Source (Octopus)
Console (Depth & Air Pressure Gauges)
Compass
Fins
Boots (for open-heel fins)
Mask
Snorkel
Shorty or 3mm or thinner full-length wetsuit
Dive computer
Dive Knife
Gloves
Safety Baloon (SMB)
Rescue Pocket Mask
Weight belt (Belt only, not weights)
Torch / Light
Gear Bag

Equipment Upgrades

Are you interested in upgrading any of the items in your standard package? If so, indicate which items below. Click here for upgrade options.

Books & Study Aids You Own Now

Which of the following books & study aids -- current editions -- do you already own?

All these are required and you must show us you have these for your instructor / divemaster course.

NONE. I need all Books & Slates
I own ALL of the below. I will bring these to the center upon arrival for verification.

Open Water Manual
Advanced Open Water Manual
Emergency First Reponse Manual
Emergency First Response Care for Children Manual
Rescue Diver Manual
PADI Emergency Oxygen Provider Crew Pack

Divemaster Course Materials
Divemaster Manual
Encyclopedia of Recreational Diving
Divemaster Knowledge Workbook
Divemaster Slates
eRDPml (eRDP Version 2.0 Multi-Level)
Discover Scuba Diver Aquatic Cue Slate
PADI Instructor Manual 2010 (DM-only Internships )

Instructor Development Course Materials
PADI Instructor Manual - 2010 or later
PADI Guide to Teaching Manual
Confined Water Lesson Preparation Slate
Open Water Training Dive Lesson Planning Slate
Open Water Aquatic Cue Cards - Confined Water
Open Water Aquatic Cue Cards - Open Water
Adventures in Diving Aquatic Cue Slates
Rescue Diver Aquatic Cue Slates
Open Water Diver Quizzes and Exams
Rescue Diver Final Exams
Divemaster Exams
Law & the Diving Professional Manual
Law & the Diving Professional Manual Best of Undersea Journal, Children & Diving and Business of Diving Manuals or CD-ROM
Business of Diving: Positive Approach Selling DVD
EFR Instructor Manual w/Care for Children Supplement
EFR Instructor At a Glance Card

Master Scuba Diver Trainer Materials
PADI Specialty Instructor Manual

IDC Staff Instructor Materials
PADI Course Director Manual 2007 Version
20 Skills Evaluation Slate
IDC Staff Evaluation Slate C/W
IDC Staff Evaluation Slate O/W.2007 Version

Visa Assistance

1 ) Do you require visa assistance?

Yes No

2 ) If yes, will you be acquiring your visa in your home country or after you come to Thailand?

In home country (recommended)
After coming to Thailand

Accommodations

Specify whether you require accommodations and for how long. Basic and luxury accommodations are available. Click here to see them.

Standard accommodations (Included in price)
Luxury accommodations (Approx. $500/month extra)

Enhanced Learning Packs

Do you want to gain more experience and improve your job prospects? If so, you can purchase 1 or more Enhanced Learning Packs. Click here to read what courses, books and equipment each package includes.

PADI Enhanced Learning Pack - $799
Includes all the optional manuals for the free Eco-Diver 2010 Training Pack, plus 2 more courses and manuals.
Dive Medic Professional Enhanced Learning Pack - $999
Save 30% on this suite of 6 courses, all manuals, 2 DVDs, 2 exam booklets and more.
Technical Diving Enhanced Learning Pack - $1,999
Save 25% of this suite of 4 courses, all manuals, 3 pieces of equipment and more.

Comments

This form is for internship reservations only. If you simply want to ask a question without reserving a course, click here. All others, add any addtiional comments below.