Ecole d'Espagnol

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REGISTRATION and booking FORM

Airport pickup USD 10.--. You will receive a confirmation from the school!

* information required

PERSONAL DATA

*Family Name:
*First Name:
*E-mail:
Mailing Address:
Country:
Home Phone:
Business Phone:
Fax:
Occupation/Profession:
Age:
*Gender: Female Male

ARRIVAL INFORMATION

Date: D /M /Y
Local hour/time:
Airline:
Flight Number:
I don´t wish airport pickup

*SCHOOL

*I wish to study...
       
From:   Day /Month /Year
To:   Day /Month /Year
*Level of classes: Beginner Intermediate Advanced

**WHERE TO STUDY

Quito # of weeks  
Coast-Puerto Lopez # of weeks  
Jungle (one week program only)      
( you may choose to study in more than one location-please specify # of weeks for each)

TYPE OF HOUSING

* if you would require arranged accomodation

Homestay-Family
Hostal/Hotel
 
From:   Day /Month /Year
To:   Day /Month /Year

If you wish a homestay family please specify the following:
breakfast only
2 meals
3 meals
I am vegetarian

Additionally i'm booking the
following services.......

Student Trip Ecuador w/Galapagos Date: D /M /Y  
Yarina Lodge additional Week after Student Trip  
Flight Quito-Coca-Quito to the Yarina Lodge (US$ 120)  

I HEARD ABOUT LA LENGUA THROUGH.........

Other, please specify:

Special requests, questions or comments:

Thank you for choosing LA LENGUA, we look forward to meeting you!