HSA Orlando
HSA Orlando

HSA Instructor Training Course Application

November 12 - 13, 2005
February 25 - 26; May 06 - 07; August 19 - 20; November 11 - 12, 2006

Sponsor: Leslie Koontz
The Living Seas at EPCOT, Walt Disney World - Orlando, FL

Cost: $475.00

Includes course fee, materials, all SCUBA equipment, certification, and dives at The Living Seas (a $280.00 value)

The course will be conducted at The Living Seas at EPCOT, Walt Disney World - Orlando, FL

  • Saturday - 9:00 a.m. to 6:00 p.m.  Academics & Exam
  • Sunday   - 9:00 a.m. to 6:00 p.m.  Confined Water Skills & Open Water Dives

The amount of time required for each day may vary. PLEASE DO NOT MAKE ANY PLANS THAT WILL INTERFERE WITH ANY OF THESE DAYS.

Please bring:

  • Two passport-sized photographs of yourself
  • Certification card (Instructor, Assistant Instructor, Divemaster)
* All materials and dive equipment are provided and included in the price of the course.


Deposit:  $100.00   Due at time of registration
Note:  Balance due 30 days prior to course start date. If registration is within 30 days of course start date, balance is due in full at time of registration.

Please enroll me in the ITC scheduled for (date)______________

Payment: Make checks payable to Leslie Koontz.

Name ______________________________________________

Address ___________________________________________

City ______________________________________________

State/Province_______________________________________

Zip ____________________

Country __________________

Phone ______________________ E-mail ____________________

Certification:  [ ]  Instructor  [ ]  Assistant Instructor  [ ]  Divemaster

Certification Number ______________________

Certification Date _____/_____/_____

Send completed application and payment to:
Leslie Koontz
19 Wentwood Dr.
De Bary, FL 32713
 

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