Please complete the following information and we will send a confirmation email upon receipt and send via email pre-arrival orientation information.

*Required fields Personal information
Mrs,/Ms./Mr.
Name*
Address*
Citizenship*
Email*
Phone*  +    Cell*  + 
Profession
Date of birth Day    Month    Year 
Health Problems .
Telephone and name in case of emergency:

PAYMENT TERMS: 		Cash when I get there   Yes    No

Send a check to the following address: Spanish Immersion Costa Rica Apdo 178-4013 Atenas, Alajuela, 20501 Costa Rica
COURSE DETAILS
First day of classes* Day    Month    Year 
Last day of classes* Day    Month    Year 
Course type Beginner:    Intermediate:    Advanced: 
Have you studied
Spanish before:   		Yes    No 
If yes, for how long:
Accommodation Start Date* Day    Month    Year 
ARRIVAL INFORMATION
Flight#  Time: 
Airline:   
Date of arrival day: Day    Month    Year 
Pick up at the airport Yes    No