Personal Information

Name
Password
e-mail
Alternative e-mail
Nationality
Passport number
Address
City
State
Postal Code
Country		Argentina Alemania Australia Austria Bangladesh Belgica Bolivia Brasil Bulgaria Canada Chile China China - Hong Kong S. Colombia Corea Croacia Dinamarca Ecuador Egipto Eslovaquia Eslovenia España Estados Unidos Estonia Filipinas Finlandia Francia Grecia Holanda Hungria India Indonesia Irlanda Israel Italia Japon Lituania Luxemburgo Malasia Mexico Nueva Zelandia Noruega Pakistan Paraguay Peru Polonia Portugal Reino Unido Republica Checa Rumania Rusia Singapur Sudafrica Sri Lanka Suecia Suiza Taiwan Tailandia Turquia Uruguay Venezuela Vietnam
Telephone
Date of Birdth		1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
Gender		Select Female Male
Native Language
I found Elebaires through		(please be specific)
If personal recommendation, who?

Program Information

Class start date		ex.: 01-01-1900
Class end date		ex.: 01-01-1900
Number of weeks		1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Program Type		Intensive (20 hs group) Individual (10 hs private) Super Intensive (group/private) Semi Private (10 hs) Customized: (Medical, business, etc)
Special Programs		Spanish and Tango Spanish and TEFL Spanish and Volunteer Spanish and Intern Business Spanish
Additional program specifications
For private lessons or customized content. Please indicate the number of hours per week you would like to have
Please briefly describe your subject content interests
Spanish level		No Spanish Beginner Lower Intermediate Intermediate Advanced Intermediate Advanced Expert

Accomodation

Accommodation Type		Select Shared Student Apartment Homestay with Meals Homestay w/ out Meals Student Residence Bed and Breakfast
I am part of a couple requiring a shared bedroom		Select No Yes
Housing Start Date		ex.: 01-01-1900
Housing End Date		ex.: 01-01-1900
Pet/Food allergies		Select No Yes
Dietary needs		Select No Yes
Additional or other special needs
Do you mind if there are children in the family?		Select No Yes
Are you a smoker?		Select No Yes
Do you mind if there are smokers in the family?		Select No Yes
Volunteer Placement		Select No Yes
If yes, briefly describe your volunteer interests
If yes, briefly describe your volunteer interests
		Students must be willing to commit to at least 4 weeks of interning in the same location.
Volunteer Start Date		ex.: 01-01-1900
Volunteer End Date		ex.: 01-01-1900
Internship Placement		Select No Yes
If yes, briefly describe your internship interests
		Students must be willing to commit to at least 4 weeks of interning in the same location.
Internship Start Date		ex.: 01-01-1900
Internship End Date		ex.: 01-01-1900

Support Services

Cell Phone		Select No Yes
How many weeks
Language Exchange Partner (Intercambio)
Comments

Arrival Information

Do you desire airport pick-up?		Select No Yes
Date of Arrival
Time
Flight
Airline

Emergency contact Information

Full name
Street address
Phone number
City
State Province
Zip/Postal Code
Country
Email
Relation

Workshops Buenos Aires

Please mark the workshops you are interested in. Upon the start of your program, the school will coordinate your workshops.

Tango		Select No Yes
Photography		Select No Yes
Wine Tasting		Select No Yes
Cooking		Select No Yes
Scuba Divings		Select No Yes
Polo		Select No Yes
Skydiving		Select No Yes

Excursions

Colonia, Uruguay		Select No Yes
Iguazú Falls, Argentina		Select No Yes
Mendoza, Argentina		Select No Yes
Calafate, Argentina		Select No Yes
Montevideo, Uruguay		Select No Yes
Mar del Plata, Argentina		Select No Yes
Other

Payment method

Payment method		Select Visa MasterCard AMEX Discover (PayPal) Cash
Payment Preference
Comments

Additional Information

Likes and Dislikes
Expectations