ILC - Interactive Language Centre

Interactive Language Centre Universidad Vizcaya de las Américas Arq. Antonio Rivas Mercado No. 7 Col. Centro C.P. 63000 Tepic, Nayarit. México	Phone and Fax number: 011 52 311 133 2791 Cel Phone: 011 52 311 230 3696 E-Mail: ilc@interactivelanguagecentre.com

Personal Information
First name
Second name
Last name
Address line 1
Address line 2
City
Country
Phone number (include area code)
Home
Cel.
Work
Age if under 18
Number of people in your party
Male Female Married Single
Course Information What do you think is your level of Spanish?
None Basic Intermediate Advanced
Arrival Date
Departure Date
Number of days or
Number of weeks
Means of Transportation
Car Plane Other
Housing
Will you require help with accomodation?
Yes No
If so what type of accomodation will you require?
Hotel Homestay Other
Any Special Requirements that you find necessary

Cost $150.00 USD per week, per person. A 10% non refundable deposit will be required upon registration. Method of Payment to be determinated at the time of registration.

NOTE:

Please fill out this registration form, print it and send it by FAX or EMAIL.

Thanks.