UniSpain - Study Spanish in a university or private language school in Spain

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Registration Form UniSpain

You are required to fill out all sections typed in red. The information in this registration form will only be used by UniSpain for purposes regarding your registration and your stay in Spain.

Personal Information:
Name:
Surname:
Address:
City:
State:
Postal Code:
Country:
Email:
Home Telephone:
Work Telephone:
Emergency Contact (Name & Phone):
Nationality:
Date of Birth:
Passport number:
Sex:	Male Female
What best describes you?
What is your current level of Spanish?

Program Information:
Program 1:	.
In which town do you want to study in?
The name of the school?
What type of program?
How many hours per week?
Start date
Number of Weeks
Program 2:	Only fill in program 2/3 if you want to combine courses in different towns
The name of the school?
What type of program?
How many hours per week?
Start date
Number of Weeks
Program 3:	.
The name of the school?
What type of program?
How many hours per week?
Start date
Number of Weeks

Accommodation Information:
Accommodation 1:
Accommodation Type	Host Family (Half Board) Host Family (Full Board) Shared Flat Own Flat Pension or Hotel No Accommodation Requested
Are you travelling with a Companion?	Yes No
What is the name of your Companion?
Please select room	Single Room *Double Room
Start Date:
End Date:
Accommodation 2:
Accommodation Type	Host Family (Half Board) Host Family (Full Board) Shared Flat Own Flat Pension or Hotel
Are you travelling with a Companion?	Yes No
What is the name of your Companion?
Please select room	Single Room *Double Room
Start Date:
End Date:
Accommodation 3:
Accommodation Type	Host Family (Half Board) Host Family (Full Board) Shared Flat Own Flat Pension or Hotel
Are you travelling with a Companion?	Yes No
What is the name of your Companion?
Please select room	Single Room *Double Room
Start Date:
End Date:

*Only available when reserving with a companion

*Special Requests:
Host Family:
Family Request
Family Request
Family Request
The Family:
Diet Request:
Allergies:
Other Comments:
Shared Apartment:
Nationality:
Gender:
Other Comments:

*We can not guarantee to comply your requests

Prices:
Course Fee:
Accommodation Price:
*Airport Pick-up Price:
Other (late fee, program changes)
Total Price:

*Airport pick-up is optional and only includes pick-up - not return

Payment Arrangement:
To insure your place in one of our programs you have to submit a registration form including either the full amount of the program Or a deposit of 200 � (Remember! this is a deposit and NOT A REGISTRATION FEE and will be DEDUCTED in your total amount. The deposit is used to pay the school deposit fee).
Do you wish to pay the full amount now or only the deposit?	Full Amount Deposit
How do you wish to pay the deposit?	Credit Card# Bank Check Personal Check Money Transfer
How do you wish to pay the total amount?	Bank Check Personal Check Money Transfer

#If you wish to pay by credit card you will receive an email with details about how to pay via Paypals secure online payment site.

Comments:
Please specify any other comment here.

I have read and agree upon all Terms & Conditions

UniSpain, part of Accom Consulting Spain S.L.
Armengual de la Mota 24, 1B, 29007 Malaga, Spain.
Email: [email protected].
Phone: (+34) 652 898 476/ 635 618 768.
Fax: (+34) 952 27 08 94.

Copyright � 2001 Accom Consulting Spain S.L. All rights reserved.