KSC BARRACUDAS DIVE RESERVATION REQUEST FORM
*** ONE RESERVATION REQUEST FORM PER PERSON OR HOUSEHOLD PER TRIP ***
 
Destination/Date(s):
PLEASE RESERVE SPACE FOR:
NAME OF DIVER/GUEST:
MEMBER
GUEST
 
Note: If you are a guest, please list the name of your sponsoring Barracuda:
Guests (i.e. nonmembers of the Barracudas) will be assessed a 5% surcharge for their reservations.

     
 
   
 
 
Person to notify in case of emergency while on trip
This section MUST be completed
 
Street Address    
   
ENCLOSED IS A CHECK FOR:
TOTAL: $
BALANCE DUE: $
Note: You are financially responsible for your trip reservation. Names of alternates, if available, can be obtained from the Trip Coordinator in the event you should need to cancel your reservation. Mail this reservation request form aling with your payment to the address given below.
 
For Trip Coordinator use only: Date received:
 
3. Write a check for the amount listed above.
4. Mail form and check to:
KSC Barracudas
IT-C1
Kennedy Space Center, FL 32899