Book a Course

The following form should be filled out by participants who are registering to a special program NOT found within the online program search.

Please complete the form below. Mandatory fields marked *

Note: Please do not use special characters like accents. The $100 registration fee will be added at the end of your total program fee. This is a one time fee, per program, applied to each participant.


PERSONAL DETAILS

First Name (as is on passport)*

Last Name (as is on passport)*

Date of Birth

Date

Passport Number

Gender



Country

Address*

City*

State*

Zip Code*

Home Phone*

Work or Cell Phone

Emergency Contact

E-mail*

Occupation

How did you hear about us?

PROGRAM

TYPE OF PROGRAM




Arrival Date

Departure Date

Course Start Date

Course End Date

Lessons/Day

Current Language Level

Comments

IF YOU HAVE CHOSEN ACCOMMODATION

1.

Children




Smokers





Same Lodging?



Same Room?



Same Bed?



Accommodation runs from Sunday to Saturday. If you would like to arrive earlier or leave later, extra nights need to be arranged and an additional cost. Will you require extra nights?



TRAVEL INSURANCE

Do you have a Travel Insurance?



Do you need EasyGO Languages“s Travel Insurance?


Number of Weeks

Number of Weeks

IF YOU ARE TRAVELING TO THE USA

Under what type of VISA will you travel?
Additional Comments
Special Promotion Code
Do you have a Travel Insurance?


Do you need EasyGO Languages“s Travel Insurance?


I agree with terms and condition

Book Volunteer ProgramBook Volunteer Program
Book Internship ProgramBook Internship Program

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| 275 NE 18th St. Suite 1902,Miami FL 33132
| Email: info@easygolanguages.com

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