PROGRAM APPLICATION
Check One:       _____ Two-week Program           _____ Four-week Program           _____ Six-week Program
Last Name First Name
E-mail
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.)
New York
Miami ($55)
Atlanta ($95)
Getting own airfare
(credit $1,200)
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.  
CULTURAL ACTIVITIES: (Check your choices)
Four to Six Week Programs
  Package of Four City Tours: $195
  Package of cultural activities : $165
Excursions:
Barcelona, July 11-14    Double occupancy $450
Lisbon, July 11-14
  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
College of Central Florida
Learning Resources Center
3001 SW College Road
Ocala, FL 34474-4415