Contact Information

First Name
Last Name
Address
City		St.	ZIP
Phone:		Fax:
E-mail:

Travel Information

Ever been to Maui?	Yes No
Preference of food?
Do you have medical coverage?	Yes No
Last Tetanus Shot

Reservation Information

Week (dates) selected:
Choose January 2001: 01/08-01/11 01/15-01/18 01/22-01/25 01/29-02/01 February 2001: 02/05-02/08 02/12-02/15 02/19-02/22 02/26-03/01 March 2001: 03/05-03/08 03/12-03/15 03/19-03/22 03/26-03/29 April 2001: 04/02-04/05 04/09-04/12 04/16-04/19 04/23-04/26 04/30-05/03 May 2001: 05/07-05/10 05/14-05/17 05/21-05/24 05/28-05/31 June 2001: 06/04-06/07 06/11-06/14 06/18-06/21 06/25-06/28 July 2001: 07/02-07/05 07/09-07/12 07/16-07/19 07/23-07/26 07/30-08/02 August 2001: 08/06-08/09 08/13-08/16 08/20-08/23 08/27-08/30 September 2001: 09/03-09/06 09/10-09/13 09/17-09/20 09/24-09/27 October 2001: 10/01-10/04 10/08-10/11 10/15-10/18 10/22-10/25 10/29-11/01 November 2001: 11/05-11/08 11/12-11/15 11/19-11/22 11/26-11/29 OTHER

Availability list updated monthly, but not more than a year in advance.

Should you desire to reserve other dates, please list them below by order of choice. (Confirmation will be based upon availability.)

Other Dates here

Surfing Information

On a scale of 1 - 10 what rating would you give your self as a surfer 1 2 3 4 5 6 7 8 9 10
Stance: Are you goofy or regular foot? (Goofy stands on a skateboard or surfboard with the right foot forward) regular goofy
What wave sizes can you surf?	1-3 feet 3-6 ft 6-10 ft. 10 ft plus
Board size you like to use	6 ft - 6'6 6'8 - 7'2 ft Minitanker LongBoard Not Sure
Your Weight & Height?
Additional Comments or questions?