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Registration Form

 

Please use the following form to email us your preferences in relation to attending our school. Please be sure to complete or make a selection in all the fields, so that we can best serve your needs.

 

If we can be of further help to you please do not hesitate to either call, fax, or e-mail us. Our interest is in providing you with enough information so that you can make a wise choice.

 

General Information

Type of Application:
How did you hear about us?
Name:
Address:
Date of Birth: Day:Month:Year:
Gender:
Phone:
Fax:
E-mail:
Occupation:
Nationality:

 

Course Information

 

1. Do you have any knowledge of Spanish? Yes No
2. Level?
3. For how many weeks do you wish to study? Weeks:
From:
To:
4. How many hours per day?
5. Program of Study?
6. Arrival Information:
Month of Arrival:
Day of Arrival:
7. Flight Information:
Airline:
Flight Number:
Time of Arrival
8. Housing Preferences and Special Considerations:
Smoking: Yes No  
Yes No  
With Children: Yes No  
With Pets: Yes No  
Type of Room: Single Shared Matrimonial  
Allergies:  
If you have any specific requirements, please specify bellow.
9. Other preferences and comments:

 


718 Jorge Washington St. and Amazonas Ave.
Building Rocafuerte, Washington Block, Third Floor.
P.O. Box: 17-21-1245
Quito - Ecuador / South America		 Telefax: (593-2) 2504654, (593-2) 2548223
Mobil and emergency phones: (593-9) 5090901, (593-9) 8331098
E-Mail us: info@eduamazonas.com