UCI, LLC
Training Application Form
Name DOB / / Age M F
Home Address
City/Town State Zip
Occupation
Department Affiliation
Business Address
Home Phone - - Bus. Phone - -
Cell-Phone - - FAX - -
E-Mail Address
Current level of training
Estimated number of dives made to date
Dive Team Name
Your Title
Which course are you wanting to attend?
How did you hear about this course
Prerequisites:
You need to be an Advanced Open Water or equivalent diver with any nationally recognized diving agency or a military or commercial diver. You need to be 18 years old or older and a member of a law enforcement, fire, or rescue department or if you are in a position to assist your community, state or government in underwater criminal investigations or with other public safety diving assignments.
Price of the course includes all student books, quarry fees, licenses, and diplomas. (There are no hidden cost)
Make check out to: UCI
Our Address is: 212 Tall Oaks Drive, Emporia, VA. 23847
Phone Number: 434.348.7333
