.Registration Form .
First Name
Last Name
Address
City State
Zip Code
Tel (home) Tel: (work)
Fax    
If student what school did you attend?
Date of arrival in Cueranavaca? DD MM YY
Monday Date of Enrollment
Number of Weeks Approx. level of Spanish
Request Transport from Mexico City to Cuernavaca Yes No
If Yes - Day and Date of Arrival DD MM YY
Airline Flight No#
City of Origin

Time of Arrival AM PM
Return Date: DD MM YY
Departing Mexico City: DD MM YY
.
Preferred Family Plan

Private Room With Semi-Private Bath Single Couple
Shared Room and Bath  
Medical Restrictions:
Preferences Children Yes No
  Smoking Yes No
.
Emergency Contact Details

Name
Relation
Address
City Tel
If traveling with a companion, wish to share a room with
Name  
Type Of Program Chosen Regular Semi-Private Executive