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Application
Please fill out the following form to enroll in one of our Spanish language courses. If you only wish to receive information, to download our brochure or want us to call you use our contact page

All fields with an * have to be completed.
Personal Data
First Name *     Year of birth *
Family Name *   Gender *
Company   Profession
Street   Nationality
Zip / City   Spanish knowledge
State/Province   When and how did you learn Spanish? (nº of lessons, course and school type, etc.)
Country *  
E-mail * (please
double check!) 		  What contents have you studied
Phone  
Fax  

Course (s)
Course Start and Duration:  
Type of course
Description
A (Standard) 20 Spanish lessons/week
B (Intensive) 30 Spanish lessons/week
C5 (Combined) Course A + 1 private less./day
C10 (Combined intensive) Course A + 2 private less./day
P (Private lessons) Number of lessons/week:
P10 (Private lessons) 10 private lessons/week
P20 (Private lessons) 20 private lessons/week
P30 (Private lessons) 30 private lessons/week
T2 (Teacher Workshop) 10 private lessons/week
T3 (Teacher Workshop intensive) 15 private lessons/week

Accommodation
(for description and prices go to: accommodations

I require an accommodation: yes no
Please indicate the code name(s) of your favorite accommodation:
1: 2: 3:
Or indicate your lodging options:
  apartment (550 - 2730 EUR/2 weeks) --> My max. price: (EUR)
  shared (234 EUR/2 weeks) private bath (+88 EUR/2 weeks)
  family (385 EUR/2 weeks) private bath (+62 EUR/2 weeks)  
  hotel (572 - 1885 EUR/2 weeks) --> My max. price: (EUR)
Arrival day: Departure day:    Airport pickup (+75 EUR)
I am a: Non smoker Smoker
I mind living with smokers: Yes No
Additional comments
Payment (for the advance 180 eur.)
(for the advance payment of 180 EUR)
I would like to pay by: *
(In case of money transfer, please send receipt by fax to +34-914 324 541)
Credit card nº:
Exp. date:
Name on card:
I prefer to give my credit card information by phone or fax  
I accept the prices * yes
I accept the conditions *
yes
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Related pages:
Home: spanish in spain This week's learners: spain school Home: learn spanish in madrid Spanish Dictionary: free spanish grammar This Week: spanish language learning



=elemadrid=
Spanish for professionals, executives and demanding adult learners
Serrano 4, 28001 Madrid, Espagne
Tel. +34-91-432-45 40 | Fax: +34-91-432-4541
mail@elemadrid.com
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