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Registration Form - Part 1 of 2

2012 Youth Summer Language Program - Ages 14-17

Personal Information

Male Female
Family/Last Name (as in passport) First Name (as in passport) Second Name (as in passport)
Date of Birth: Country of Citizenship:
First Language: Other

Mailing Address

Current Street Number and Name Apt. Number City
Province/State Postal Code Country
 
Telephone: Area Code and Number  

Academic Information

Grade completed as of June 30th 2012?
GR.9 GR.10 GR.11 GR. 12

Program Sessions

3-Week Program $3,650.00 Mon. July 02 - Fri. July 20, 2012

How did you hear about this program?:

Friend
Internet
Agent
Other


Registration Details:

An email address in required in order to obtain all your confirmation documents and program information.

Student E-mail

Within 3 days your application will be processed and the Registration Form Part 2 will be sent to the email address you provided above.
Upon receipt of Registration Form - Part 2 a non-refundable deposit of $200 is required to guarantee your spot. Acceptable forms of
payment include Credit Card ( Visa,Master Card) , Money Order, Bank Draft or Wire Transfer. Payment instructions will be provided

.