Return completed application below with the first installment of $900 plus the registration fee.
PROGRAM APPLICATION
       
Check One:       _____ 2 Week Program           _____ 4 Week Program           _____ 6 Week Program
Last Name First Name
E-mail
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)
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)
1.2.
3.  
CULTURAL ACTIVITIES: (Check your choices)
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
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
Central Florida Community College
P.O. Box 1388
Ocala, FL 34478-1388