Enrolment form
   
Thank you for choosing EPatagonia-Program
Please complete the enrolment form below to reserve your place. Send the complete form to us by clicking on the 'Send' button at the bottom of this page. If you prefer, you can print the form and send it by mail or fax.
First Name:
Last Name:
Address:
Sex:

Country:
Telephone:
Other Telephone (Optional): 
E-Mail:
Emergency contact, name, address and telephone

 
Nationality:
Mother tongue:
Age:
Occupation: 
Do you have any disability?:
If so, please provide details so we can accommodate you :
Your Course:
The course you have selected:
Please enter the start and finish dates of your course : / /
/ /
Course length:
How long have you studied Spanish?
Where?
What is your level of spoken Spanish? ?
What is your level of written Spanish?
Is there any other information you can give us so that we can place you in the appropriate level?
Your arrival:
Arrival date: / /
Departure date: / /
Accomodation:
Do you want us to arrange family accommodation for you?

What type of family would be acceptable?:
Do you smoke? :
Are you a vegetarian?:
Do you want us to arrange other accommodation for you?:
Please specify the type of accommodation you require :
Special homestay requests:
Activities:
Usted está interesado en: Tourism
 Ski/Snowboard
 Trekking
 Raffting
 Fishing
 Mountain Biking
 Scuba diving in Península Valdés
 Whale watching in Península Valdés
 Fútbol (soccer)
 Tennis
 Golf
Are you interested in taking ski classes?

Other information:

  
How did you find out about the EPatagonia Program?

 
Is there any other information you would like to give us at this stage?

 
 

 

  
  In Bariloche - Argentina - E-mail: info@epatagonia.edu.ar
Phone:/Fax: 54 (2944) 42-0567
Address: Av. de los Pioneros 38, Bariloche, Provincia Río Negro CP(8400), Argentina