Vallarta Adventure - Fax Reservation - (52) 322-297-1252

Thank you for booking with Vallarta Adventures. To request a reservation, please fill in the details below and fax to  (52) 322-297-1252.  Click here to print this page. Guest Information Name:  _________________________________________________ Street Address:  _________________________________________________ City:  ________________________  State:  ________________________ Zip Code:  ________________________  Country:  ________________________ Email: [you@yourhost.com]  ______________________________ A reservation confirmation will be sent to the email address provided. Phone:  ________________________  Fax:  ________________________ Arrival Date:  __________  Departure Date:  __________  Where Staying:  ______________________ Comments/Questions/Requests: __________________________________________________ _______________________________________________ [all prices reflect 10% online discount] LEARN TO DIVE PROGRAMS * The location and time of your lesson will be confirmed by email Resort Course - ____ @ $31.50 USD - Date _______________ Refresher Course - ____ @ $31.50 USD - Date _______________ Bubblemaker for Kids - ____ @ $27 USD - Date _______________ SNORKELING & DIVING TOURS Las Caletas Snorkel - ____ Adults @ $70.20 USD - ____ Children @ $35.10 - Date _______________ Las Caletas Dive - 1 tank ____ @ $70.20 USD - 2 tank ____ @ $81 - Date _______________ Marietas Island Snorkel - ____ Adults @ $58.50 USD - ____ Children @ $29.25 - Date _______________ Marietas Island Dive - 1 tank ____ @ $70.25 USD - 2 tank ____ @ $81 - Date _______________ El Morro Dive - 2 tank ____ @ $90 USD - Date _______________ Los Arcos Night Dive - 1 tank ____ @ $72 USD - Date _______________ Corbetena Dive - 2 tank ____ @ $117 USD - Date _______________ Scuba Pack - 4 day/8 tank special ____ @ $315 USD - Date _______________ PADI COURSES PADI Open Water Certification - ____ @ $333 USD - Date _______________ PADI Open Water Referral - ____ @ $242.10 USD - Date _______________ PADI Advanced Open Water - ____ @ $297 USD - Date _______________ PADI Rescue Diving - ____ @ $297 USD - Date _______________ PADI Dive Master Course Program - ____ @ $517.50 USD - Date _______________ OTHER COURSES Beginning Underwater Photo Course - ____ @ $171 USD - Date _______________ Underwater Snapshot Course - ____ @ $54 USD - Date _______________ Medic First Aid - ____ @ $76.50 USD - Date _______________ Marine Awareness Course - ____ @ $171 USD - Date _______________ Total Above: ________ Credit Card Information Card Type: Visa _____ MasterCard _____ American Express _____ Name of Card Holder:  _________________________  Card Number:  _________________________ Card ID Number: __________  Expiration Date:   __________ (mm/yy) I authorize Vallarta Adventures to charge the totals above to this credit card account. [X]

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