* 5-17 18-25 26-35 36-45 46+
State / Provence:
Zip / Postal Code:
* USA Australia Brazil Canada Japan China S. Korea United Kingdom France Italy Spain --- Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Chad Chile Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Jamaica Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Saint-Martin (France) Saint-Martin (Pays-Bas) Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Sri Lanka St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe
Please check the countries you would like to include in your surf clinic:
Hawaiian Island your choice Oahu, Hawaii Gold Coast Australia & Upper NSW Request for Nancy to bring Aloha Surf Clinics to your area Namotu, Fiji (not for beginners and allow 3-6 months advanced booking)
Would you like suggestions for your accomodations?
--- Hotel Motel Condo/Apartment Airbnb Youth Hostel
For Nancy Emerson School of Surfing, Aloha Surf Clinics or Gold Coast Australian School of Surfing to provide you with the most effective coaching, teaching and for you to receive the best out of your surfing clinic, lessons or book a surf guide.
PLEASE answer the following questions truthfully regarding your swimming experience and ability in the ocean.
Basic (I can float and feel comfortable in the water, 250 meters/100 yards in a pool or lake) Intermediate (I can identify undertow and rip currents from the shore, and know how to get out of them. When in the water, I can swim 500 meters/250 yards comfortably in a pool or lake.) Advanced (You're a Water Baby!)
Do you have any feelings about the ocean which make you feel nervous about the Ocean?
Do you have any physical ailments or injuries ie. back, knee, shoulder, neck pain?
If Yes, please provide details:
Have you had any experiences during your childhood or adult life that have left you feeling uncomfortable with "Our Mother Ocean"?
Have you ever surfed before?
none once a few times monthly all year round
What is your ability?
First Time Beginner Advanced Beginner Intermediate Seasoned Competitve
Where have you surfed, what size of waves have you ridden?
What size and shape of surfboard have you used or what are you currently using?
Long Board Mini-Mal Short Board Body Board
Are you bringing your own boards or do you want to use our equipment during your clinic or classes?
I'm bringing my own board I want to use your equipment
Choose Instructor Classes
Your choice of instructor (refer to rate page)
Instructor (certified) Chief Instructor Nancy Emerson (if available) Combination
For combination please add your preference, ie. 1 day Chief Instructor and 2 days Nancy Emerson
Are there any other details that the Nancy Emerson School of Surfing needs to know regarding your intended trip to make things easier or more comfortable for your Surfing Experience?
What type of lessons or surf clinic are you interested in?
What type of lessons or clinic are you interested in?
Group 2 hour Private 2 hour Private Private w Chief instructor Semi-private 3-5 Day Clinic Private Clinic - With Chief Instructor Working with Nancy Emerson Working with Surf Guide
How many will be in your group (3-5 people)?
Height, Weight of each person surfing and their name?
Thank you very much for filling out our reservation form which will help greatly in assisting in planning your surfing clinic or class with Nancy Emerson School of Surfing or on Aloha Surf Clinics with Nancy Emerson or the Gold Coast Australian School of Surfing.
PLEASE refer to the Rate Page on the Web site for questions to our options or Nancy can help in creating a combination for your surfing with them.