Spanish Institute of Puebla - Registration Form

Spanish Institute of Puebla

Spanish Immersion in Mexico Since 1984

Puebla
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Registration

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:	Area code: Number:
E-mail * :
Sex:	Male Female
Marital Status:
Age:
Profession:
Person to contact in case of emergency:
Phone:	Area code: Number:
Select your program:	Group program Individual program
Group program:	Starting Dates: No. of weeks:
Individual program:	Starting dates: No. of weeks:
Do you want host family?	YES NO
Requests regarding homestay:

Spanish level you would like to start in:	Take placement test (optional)
Knowledge of Spanish: (25 words or less)
Deposit ($100 usd) will be paid by:	Check Credit Card
Credit card information:	Credit Card number:
Expiration date:	Card verification code:
Please, use this space for your 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:
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Other source:
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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.

sipuebla

Spanish Institute of Puebla

11 Oriente #10, Centro Histórico

Tels.: 1-800-554-2951 (USA & Canada),

+52-222-242-2062 (Other Countries)

E-mail: info at sipuebla.com