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| Check One: _____ 2 Week Program _____ 4 Week Program _____ 6 Week Program | |||
| Last Name | First Name | ||
| Address | |||
| City | State | Zip | |
| Phone | Sex | Age | |
| SS# | |||
| ACCOMMODATIONS: (check one) | ||
| Barcelona: | Hotel Double Occupancy | |
| Madrid: | Student dorm (Single rooms only) | |
| Paris: | Hotel double occupancy | |
| Lisbon: | Hotel double occupancy | |
| PLACE OF DEPARTURE: (Check one. Surcharge in brackets.) | |||||
| New York | Miami ($265) | Atlanta ($285) | |||
Getting own airfare (credit $855) |
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| COURSES: Select the course number from
the ones listed in the Program. Choose only one course from each section
but do not exceed two. Third course only for six-week program participants M (morning) A (afternoon) |
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| 1. | 2. |
| 3. | |
| 4-6 Week Program | |
| Package of 6 City Tours: $245 | |
| Package of 4 Madrid Morning Visits: $110 | |
| Barcelona Excursion: July 12 - 15 | Double occupancy $380 | |
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Lisbon Excursion: July 12 - 15 |
Double occupancy $380 | |
| Single Occupancy $315 |
Signature ______________________________________________________________________
If under 18 years old, parent or guardian must sign.
| Return Completed Application and Deposit to:
Dr. Orlando Moreno, Professor Emeritus |