PERSONAL DATA
First name:
Family name  
E-mail:
Date of birth:

Passport:

Address:

Zip code:

City:

Country:

Phone
Company

COURSE INFORMATION
Starting:
Number of weeks:    
Semi-intensive
(20 hours a week)
 

Intensive
(25 hours a week)

COURSE PRIORITIES
 
Speaking
Writing
Grammar
Others:

LODGING
 
Others:

TRAVEL INFORMATION

Do you need any help with your travel arragements?

Do you wish to be picked up at:


Payment
Further comments

 

 
   
 
Ramirez 1345 Iquique - Chile Fono (56 57) 41 1827 Fax (56 57) 429343 mail: info@languages.cl www.languages.cl