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| Check One: _____ Three-week Program _____ Four-week Program _____ Six-week Program | |||
| Last Name | First Name | ||
| Address | |||
| City | State | Zip | |
| Phone | Gender | Age | |
| SS# | Passport # | ||
| ACCOMMODATIONS: (check one) | ||
| Barcelona: | Hotel double occupancy | |
| Lisbon: | Hotel double occupancy | |
| Madrid: | Student dorm (Single rooms only) | |
| Paris: | Hotel double occupancy | |
PLACE OF DEPARTURE: (Check one. Surcharge
in brackets.) |
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New York |
Miami ($75) |
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Getting own airfare (credit $1,100) |
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| COURSES: Select the course number from those listed in the program. Choose only one course from each section but do not exceed two. Third course only for six-week program participants. | |
| 1. | 2. |
| 3. | |
| Four to Six Week Programs | |
| Package of Four City Tours: $175 | |
| Package of cultural activities : $155 | |
| Barcelona, July 12-15 | Double occupancy $450 | |
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Lisbon, July 12-15 |
Double occupancy $450 |
Signature ______________________________________________________________________
If under 18 years old, parent or guardian must sign.
| Return completed application and $1,000 deposit plus the registration fee to: Dr. Orlando Moreno, Professor Emeritus |