Contact/Enquiry Form

For more personalised information on the Derawan Dive Lodge please complete the enquiry form, submit and we will respond soonest. Or, simply send an email to info@derawandivelodge.com.

You can also use the following phone numbers:

• +62 431 824 445 (24hr hotline)
• +62 821 892 62599 (Chris, Manager)

Your Contact Information
Your Name	(required)
Country
Your Email Address	(required)

Accommodation Info
Arrival Date (dd-mm-yyyy)
Departure Date (dd-mm-yyyy)
Number of Rooms
Number of Adults
Number of Children
Type of Bed	Please choose Double Bed Twin Beds

Scuba Diving
I'm interested in:	Scuba Diving for days, or an all-inclusive dive package: Select a Package 5D/4N (3 days of diving) 6D/5N (4 days of diving) 7D/6N (5 days of diving) 8D/7N (6 days of diving)

Other Activities
I'm interested in:	Snorkeling Island Tours

Additional Information

You may enter additional requests and comments here:

Please note that this is NOT a booking form!