Expedition Volunteer Program Application

Please refer to our COVID-19 Virus Travel Updates

    First Name:
    Last Name:
    Date of Birth:
    Dates Requested:
    Nationality/Country of Birth:
    COVID-19 fully vaccinated (two doses):
    Select One:
    Previously Dived w/ MBDE:
    Dive Certification:
    Date issued:
    Total Dives:
    Ocean Dives:
    Deeper than 30 metres:
    Company, location and date you last worked at as a DM / Instructor (Position Dive Deck):
    Company, location and date you last worked (Position Domestic):
    Managers Name:
    Managers Telephone:
    Managers Email:
    Date employed from:
    Date employed to:
    Next of Kin Name:
    Next of Kin Telephone:
    In 100 words or less describe your role and responsibilities with the above employer:

    Medical History

    Please answer the following questions on your past or present medical history with a YES or NO. If you are not sure, answer YES.

    Do you regularly take prescription or non-prescription medication?:

    History of diving accidents or decompression sickness?:


    A high cholesterol level?:

    Frequent or severe attacks of hayfever or allergy?:

    Frequent colds, sinusitis or bronchitis?:

    Any form of lung disease?:

    Pneumothorax (collapsed lung)?:

    History of chest surgery?:

    Epilepsy, seizures, convulsions or take medications to prevent them?:

    Recurring migraine headaches or take medications to prevent them?:

    History of blackouts or fainting (full/partial loss of consciousness)?:

    Do you frequently suffer form motion sickness (seasick, carsick, etc)?:

    History of recurrent back problems?:

    History of diabetes?:

    History of back, arm or leg problems following surgery, injury or fracture?:

    Inability to perform moderate exercise (eg: walk one mile within 12 minutes):

    History of high blood pressure or take medicine to control blood pressure?:

    History of any heart disease?:

    History of ear disease, hearing loss or problems with balance?:

    History of bleeding or other blood disorders?:

    History of any type of hernia?:

    History of ulcers or ulcer surgery?:

    History of drug or alcohol abuse?:

    History of skin disorders, dermatitis, melanomas, skin cancer, etc?: