Online registration form....

Language Skills Abroad

Online registration form....

First name
Last name
Citizenship
Gender
Date of birth (MM/DD/YY)
Email address
Home phone
Cell phone
Work phone
Best time to call
Fax number
Mailing address
What is your current level of the language you wish to study?
Which language, location, and school do you wish to attend?
Type of program
If other, please specifiy
Class start date (MM/DD/YY)
How many weeks would you like to study?
Please verify the last day of class (MM/DD/YY)
Number of lessons per day
What kind of accommodations will you need?
Room type
Please list the name of any travel companion/s
Will you share a room with your travel companion
Host family meal options
Please list any allergies that you have
Please list any medical conditions which you feel we should know about
Please list any special requests or comments that would better help us to organize your program
Who should we contact in case of an emergency?
Emergency contact's cell phone number
Emergency contact's home phone number
Emergency contact's work phone number
On which credit card would you like to place your deposit of $100?
Credit card number
Expiration date
Name as it appears on the credit card
Address of Credit card holder (if different)
Phone number by which credit card holder can be reached (if different)
Email address of credit card holder (if different)
By checking the box, you verify that you are familiar with and agree to the terms and conditions outlined by Language Skills Abroad at http://www.languageskillsabroad.com/id3.html. Registration cannot be processed if box is not checked.

For questions about our language immersion programs abroad, please contact us at

info@languageskillsabroad.com

or call us at

toll free 1-877-689-9970

or from outside North America at +1-480-767-1789