HydroOptix Instructor and Retailer Registration


HydroOptix.Biz home page
(for instructors and retailers)



HydroOptix Privacy Policy


* - Indicates fields that are required to be filled out in order to process your application.
1. *Mr. Mrs. Ms.
Are you an:
*Instructor Assistant Instructor/Dive Master Instructor Trainer Not an instructor
If you're a dive shop retailer, are you a:
*Store Owner Store Partner Store Employee Not applicable
*First Name

*Last Name

*Shop Name (If you are not affiliated with a shop, then please enter "Independent."

*Address 1

Address 2

*City

*State/Province

*Zip/Postal Code

*Country

*Phone

*Fax
*E-mail

Please be sure your e-mail address is correct.

Web site URL (if applicable)

*Password
Please create a password for your registration (6 to 20 characters)
Please retype your password:
(Please double-check all the above for accuracy)

2. * Yes, I want to be trained and certified to sell Mega-DD (Double-Dome) masks.
   No, I'm not interested in training and certification.

SPECIAL INTRODUCTORY OFFER HydroOptix has a great deal for scuba instructors! After certifying through our Internet training program (it takes about 1 hour), we'll send you a MEGA-DD mask for only $90.00 + shipping.

This price is $20 below our standard wholesale price and includes the mask, coverlens, stowing plate & retractor, monocle and SeaGold anti-fog gel. You also get brochures to pass along to customers and students. This introductory offer is for a limited time, so hurry up and register (required to start the HydroOptix VisTA (Vision Trained & Authorized) program).*

Keyman/Sample Mask pricing is only available to qualified scuba professionals who hold a valid Instructor, Assistant Instructor, or Dive Master certification and who have completed the HydroOptix on-line VisTA Certification program. All submissions for sample masks are subject to review and approval by HydroOptix within the U.S.A. In many regions outside the U.S.A., HydroOptix has exclusive arrangement with local Distributors. Your qualification for Keyman pricing may be subject to approval of the Retailer / Distributor in your area.

*This offer also includes a free listing of your name, phone number and eMail address on our zip code locator, so potential customers can contact you for your services and independent counsel about our products.

3. * Yes, I want to stock MEGA-0d flat masks. (Certification not required)
   No, I don't want to stock MEGA-0d flat masks.

4. * I intend to conduct business only in the U.S.
   I conduct business outside of the U.S. (Export customer)

5. With what organization(s) are you affiliated?
(Please check all that apply. Also click the button on the right for your primary agency.)


ANDI		 Primary Certification
Agency & Instructor Number

NAUI
 Primary Certification
Agency & Instructor Number
BSAC PADI
CMAS PDIC
DIWA SDI
GUE SSI
IANTD TDI
IDEA WASI
L.A. Cnty YMCA
MDEA Other
NACD
NASDS
NASE

6.

Year of Birth



As we age, our close-focus ability changes, even decades before needing reading glasses or bifocals. We must know your age to give you our best advice.


7.

*7a. Have you had refractive eye surgery?
(i.e. Lasik, PRK, Radial Keratotomy)


Yes   No

*7b. Do you wear ANY KIND of Rx
glasses
reading glasses
contact lenses?
No, I have
perfect vision
Skip to Question #7
Sometimes I go
without Rx eyewear
Always

*7c. I am

Nearsighted
lenses required to focus on distant objects
Pick one - - - ->

 Farsighted
NOT AGE RELATED need for reading
glasses (presbyopia). Instead, you've
needed eyeglasses since you were young
20/20 (Nothing required for distance vision)

*7d. I need


Astigmatism correction


*7e. Reading correction?
Reading glasses (NOT bifocals)

(Presbyopia) Bifocals/progressive lenses

*7f. Experience wearing contact lenses?


Never Worn
Seldom
Current/Frequent
No Longer

*7g. Do you wear  
      

Contact lenses while diving?

A prescription dive mask?



Yes

Yes
No

No

8.
If you know of local eye doctors that are SCUBA divers, we could contact them on your behalf to encourage synergistic referrals.
Name of Practice
Phone number
Person to contact


 

If you are a SCUBA Instructor please complete this section.
If you're a diving retailer, please skip to Question 14

9. *Are you: Independent Shop Affiliated Both
10. Do you have / work for more than one dive shop?
(how many)

11. If not affiliated with a shop, what is the name of your business?

12. What courses do you teach?
(Please check all that apply. Also click the radio button on the right for of the course(s) you teach most.)


Resort		 Teach
Most

Technical Diver
 Teach
Most
OW Diver Divemaster
Advanced Diver (nav, night & deep) Assistant Instructor
Nitrox Diver Instructor
Rescue Diver Other
Advanced Rescue Diver

Approximately how many students per year do you teach?
13.


14.
Do you know of a local SCUBA shop that has an on-site pool, that allows customers free access to demo gear?
Shop name
Phone number
Person to contact


   
 
If you're a diving retailer, please complete this section.
If you're an instructor, you're finished! Go ahead and click the submit button.

15. *Do you have / work for more than one shop? How many?

16.
How many employees are in your organization?
 

17. Do you have an on-site pool so that customers have free access to demo gear? Yes No
18. Approximately how many students does your shop certify each year?
 



Thank you very much for taking the time to give us this valuable information and thank you for helping revolutionize underwater vision.

- The staff at HydroOptix
We welcome any comments you may have, below:


Please CLICK ONLY ONCE to apply!