Application Form

"Please fill out the application form if you are going to apply.
If you would like more information please contact us:info@learnspanishcostarica.com"

If you send in an application or any email and don't hear back from us within 24-36 hours it means we have not received it. We seem to be having some problems with the one and only national internet service provider. Please, write to us and let us know that you did not get a reply.

First name		Middle Initial
Last name
Address1:
Address2:
City
State		Zip
Country		e-mail
Phone		Fax
Occupation
Age		Male/Female

Person to notify in case of emergency:

First name
Last name
Phone
e-mail

Are you with a Group? NoYes
Group name:
Group leader:

Previous Spanish
No Yes

Level of Spanish:
Basic Intermediate Advanced Superior

How many weeks of classes are you registering for?: (Check one)

		1	2	3	4	5	6	7	8	More
Spanish Language	Weeks:

Date you would like to start classes: Month Day Year

Would you like a Costa Rican Homestay Program?
No Yes

Do you have any medical conditions or preferences we should know about?
No
Yes (if your answer is yes, use the "comments" field to specify)

How did you learn about this program:

Outside Magazine	World Wide Classroom	America OnLine	WWW Home Page
Other Student	Article	Newspaper Add	Tico Times
Costa Rica Today	Travel Book	School Flyer
Other	Specify

Yes! Make reservations for the above mentioned course.

Comments:
<-- Insert Comments -->

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For more information, contact us at:
info@learnspanishcostarica.com or ipedcr@racsa.co.cr
Tel: (506) 2238-3608
Tel/Fax: (506) 2237-1801
US Toll Free Number (888) Si Hablo or (888) 744-2256
IPED Instituto Profesional de Educación DAZA
275 metros oeste del Correo Heredia, Costa Rica
Copy Rights © 2006
Learn Spanish in Costa Rica at IPED Spanish School