Visit our web site: Brownies Palm Beach Divers
Call us at: 561 844 3483
Visit us at: 3619 Broadway Riviera Beach FL USA
 SCUBA-Training.net


The first step in enrolling in a SCUBA-Training.net course is to collect the student information. Please fill out this form carefully as the data contained is used in creating your permanent record


First Name: Last Name:
E-mail:
 UserID:
 Password:
We encourage that your e-mail address also be your UserID, but do not require it.
Your UserID and Password will be E-mailed back to you

Mailing Address:
City:
State/Province/Country:
Zip/Postal Code:
Phone:
 Fax:
 Mobile Phone:

Your name as it will appear on diploma:

Dive training level, agency and certification number (if any):

Year of birth:

You are now enrolling in the BTL Surface Supplied Diver course and your credit card will be charged $ 75.00 .