www.fenixlanguageinstitute.com

Registration Form Fenix Language Institute

Program

(*) Required

Zacatecas Program Chalchihuites Rural program

PERSONAL INFORMATION

* Name/Last Name
 
Gender: Date of Birth:
Male Female Month Day Year
Address: City:
State: Country: Zip/Postal Code:
*Telephone (include area code) Fax: * E-mail:
1.
 
2.
Profession:
Hobbies:
In an emergency, notify:
Name: Last name: Telephone: *E-mail:
Previous Spanish Education: Level of Spanish:
Do you speak any other languages? Why Spanish?
Knowledge of Spanish (25 words or less):
What Monday woud you like to begin your study ? Number of weeks:
Month Day Year
What Friday would you like to end your study ?
Month  Day Year
How did you find out about Fenix Language Institute?
Please specify if possible
HOMESTAY
Date you wish to begin your homestay: Number of nights:
Month Day Year
Shared room
Private Room
Restrictions (allergies, dietery restrictions): Other:
TRANSPORTATION
I am arriving by: Plane
Do you wish Fenix to arrange for airport pick-up service? (If you don't, you may arrive at the campus during regular office hours Monday-Friday 9:00 - 14:00; 17:00 - 19:00. Saturday 11:00 - 14:00 Hrs.)
Yes No
Flight information (If available)
Arrival Date:
Month  Day Year
Departure Date:
Month  Day Year
I am arriving by: Bus (You may arrive at the campus during regular office hours (Monday-Friday 9:00 - 14:00; 17:00 - 19:00. Saturday 11:00 - 14:00 Hrs.)
Month  Day Year
I am arriving by: Car (You may arrive at the campus during regular office hours (Monday-Friday 9:00 - 14:00; 17:00 - 19:00. Saturday 11:00 - 14:00 Hrs.)
Month  Day Year
Comments:
Method of payment:

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Fenix  Language  Institute Zacatecas, Spanish and Cultural Studies in Mexico 2010