Spanish Institute of Puebla - Registration Form

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You are on your way to Speaking better Spanish... To reserve your space in our program just fill out the following registration form and submit it. To complete your registration we require a non-refundable $100.00 usd deposit. The deposit will be used as part of your course fees.

Name:
Address:
Address:
City:
State:
Zip_Code:
Country:
Phone:
E-mail:

Sex:	Male Female
Marital Status:
Age:
Profession:
Person to Contact in Case of Emergency:
Name:
Phone:
E-mail:
Starting Date of Group Program:

Number of weeks you plan to attend:

If attending Individual Program mark below:
	Individual Program No. of Weeks:
Spanish level you will like to start in ( Take Placement Exam optional ):


Knowledge of Spanish (25 words or less):


Requests regarding Homestay:


Deposit ($100 usd) will be paid by:
	Check
	Credit Card
Credit Card #: - - -
Expiration Date:
Card Verification Code: What is Card Verification Code?

Please use this space for any comments:

How did you find out about the Spanish Institute of Puebla? (please specify if possible)
	Former student
	Employer
	Ad in newspaper/magazine
	My University/college
	I used a Web search service:
	Other source:

As soon as we receive your registration form, we will notify you by e-mail and guide you through everything you need to do for your trip to Puebla.