Last Name:      First Name:

Nationality:      Passport No:

Permanent Address:

City:      State/Province:

Country:      ZIP/Postal Code:

Phone:      Fax:      E-mail:

What is your level of underwater photography skill?:

What equipment do you plan to bring to the event? 

Would you like to participate in the night dives with HMI Lights (using U/v filter)?  Yes  No

What is your film preferences for underwater photography?

On average, how many rolls of film do you shoot underwater?

Your preferred method of payment:     VISA  MasterCard  American Express  JCB  Diners Club

Wire Transfer  Personal Check  Cash (pay upon arrival)

Please print this form and fax it to your dive operator, who will be contacting you for payment details.

Thank you for registering for the Underwater Palau International Photo Festival 2004.