CMAS

Student Registration Form

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Dive center  _____________________________________

Adress    ________________________________________

Instructor___________________________NO_____________

Course Level_______________________________________

Student information

First Name__________________Last name________________

Adress______________________________________________

City______________Country______________postal code_____

Tel________________Email___________________________

Date of birth_____________________________________

I confirm that the student mentioned has completed all the theoretical and practical exam and he is qualified to be certified as the level mentioned above

Certification date _______/__________/_____________

instructor signature       student signature          diving stamp