First Name:
Last/Surname:
Company:
Age:
18-25
26-35
36-45
46+
Children & teens 5-17
Billing Address:
City:
State / Province:
Zip / Postal Code:
Country:
USA
Australia
Canada
Japan
United Kingdom
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Argentina
Australia
Austria
Bahamas
Barbados
Belgium
Bermuda
Bolivia
Bosnia and Herzegowina
Brazil
Brunei
Bulgaria
Cambodia
Canada
Chile
China
Colombia
Cook Islands
Croatia (Hrvatska)
Cuba
Cyprus
Czech Republic
Denmark
East Timor
Egypt
Fiji
Finland
France
Germany
Greece
Hong Kong
Hungary
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kenya
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Latvia
Lebanon
Liberia
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Malaysia
Malta
Mauritius
Mexico
Monaco
Morocco
Nepal
Netherlands
New Caledonia
New Zealand
Norway
Pakistan
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Samoa
San Marino
Saudi Arabia
Singapore
South Africa
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Thailand
Turkey
United Arab Emirates
United Kingdom
United States
Uruguay
Vanuatu
Vatican City State (Holy See)
Venezuela
Viet Nam
Yemen
Yugoslavia
Home Phone:
Mobile / Cellphone:
Work Phone:
Fax:
Email Address
Confirm Email Address:
Please tick the countries you would like to include in your surf clinic
Oahu, Hawaii
Australia (depends on Nancy's availability, please request in advance)
Namotu, Fiji ( no beginners and allow 12 - 18 months advanced booked min)
Request for Nancy Emerson to bring Aloha Surf Clinics to your area
( travel expenses & fee additional)
Would you like us to organize your COMPLETE travel Arrangements? Yes:
No:
Or maybe you would just like help with a part of your arrangements, ie. Local transfers, Rental Car, Accommodations? Please Advice Us:
Preferred Accommodations:
Hotel
Motel
Condo / Apartment
Caravan
Backpackers
Dates of Travel: Arrival Date:
Departure Date:
For Nancy Emerson School of Surfing to provide you with the most effective coaching and for you to receive the best out of your clinic or lessons, PLEASE answer the following questions truthfully.
Please place a check next to one of the below that applies specifically to you in regards to your Swimming Ability:
Do you have any physical ailments or injuries ie. back, knee, shoulder, neck pain?
Yes:
No:
(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?
Select
once
a few times
monthly
all year round
never
What is your realistic level of ability?
Select
Beginner
Advanced beginner
Intermediate and above
Competitive surfer
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?
Select
Long Board
Mini-Mal
Short Board
Are you bringing your own boards or do you want to use our equipment during your clinic or classes?
Select
I'm bringing my Own Board
I want to use your equipment
Your choice of instructor (refer webpage for rates)
Select instructor
Instructor (Certified)
Chief Instructor
Nancy Emerson*
Combination
*If available.
For combination please add your preference, ie. 1 day Chief Instructor and 2 days Nancy Emerson
Are you interested in other tours or excursions during your visit? ie. Diving, Fishing, Bush walking, Theme Parks.(in Australia)
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 clinic are you interested in?
Select
Group 2 hour
Private 2 hour
Private 3 - 5 day Clinic
VIP Clinic / Adventure with Nancy Emerson
Corporate / Team Building Event
VIP International Destination
Standup Paddleboarding Class
*personally guided and coached by Chief instructor or Nancy Emerson.
How many will be in your group?
(group consists of 3 - 5 people)
Ages?