Bluegrass Dive Club
Lexington, Kentucky

Dominica - 2017 Trip Sign-Up Page

Please submit ONE form for each individual traveler.
If changes are required, please submit a
NEW form and
check the
Revision block below.
If you are attempting to cancel an existing reservation - go back to the Trip Page and select the
Cancel form.

Form Status:   Original     Revision

Traveler Information

Name:   As Shown On Passport
Travel Identification:  Passport is required. 
Please enter your passport information below:
Number:    Expiration Date:
You are responsible for providing the proper travel identification documents to board the airline and/or to enter the country and reenter the US.

Information from US Department of State Website as of 08/18/2016

ENTRY/EXIT REQUIREMENTS: Passports and visa: U.S. citizens must have a valid U.S. passport to enter Dominica. No visa is required for stays less than 6 months if you have an onward or return ticket, confirmation of accommodation, and can produce evidence of your ability to maintain yourself. There is a departure tax of US $22 assessed when leaving Dominica. Children under twelve years of age are exempt from the departure tax.

Home Phone:   Include Area Code
Home Address:  
City:         State:     Zip:              
E-Mail Address:  

Room Information

Please select "Room Type" for first person in each room.  If you are the second or subsequent person in the room, indicate that in the "Room Type" blocks and fill in "Rooming With" block. If you are a single, the club will try to match you with a roommate unless you indicate you will pay the "single rate".

Room Type:  
Smoking   NO     YES
Rooming With:  

Travel Information

There is no Group Airfare package.

Dive Information

Are You a Diver:   YES     NO
Do You Want Nitrox:   YES     NO
Do You Need Rental Gear   YES     NO

Additional Information

Shirts Available:
Please pick Style and Size below.  You are welcome to order as many shirts as you want which will be added to your trip fees. 
Polo Shirts  
"T" Shirt   
or Additional Information:

Emergency Contact Information (Optional)

Name:   Relationship:
Phone: Include Area Code
City:       State:     Zip:              
E-Mail Address:

Bluegrass Dive Club Trip Waiver

Bluegrass Dive Club
Trip Waiver Form
Change this box to "YES"                 to indicate that you have READ and AGREE to the Bluegrass Dive Club Trip Waiver and enter your initials here ==>    To view Waiver click ==> HERE

If the applicant named on this form is under the age of 18, this form will not be valid unless submitted by a Parent or someone assuming guardianship responsibility for applicant.  Please enter name of Parent/Guardian submitting this form.  

The Bluegrass Dive Club does not require but recommends you secure a "Child Care Authorization" document for any non-custodial person under the age of 18 you plan to bring.  Click ==> HERE for a PDF copy of this form.

Submit Form:       

Please be patient - Form may take a short time to process - You will see a confirmation page when complete.  You may want to print this page for your records.


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Copyright 2018 Bluegrass Dive Club
This Page was last modified02/23/21