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REGISTRATION FORM

Send us an e-mail: info@mundoverdespanish.com or fill out this form

Personal details
Full Name
Nationality
Passport number
Date of birth (dd/mm/yy)
Address
City
State/province
Country
Zip code
Telephone
E-mail
 
Year of studies
University
Coordinator name
Coordinator E-mail
Coordinator telephone
Starting Date (dd/mm/yy)
Ending Date (dd/mm/yy)
Duration of the elective (weeks)
Area of specialty
Second area of specialty
Spoken languages
Spanish level

Arrival information
Arrival date to Peru (dd/mm/yy)
Airline
Flight number
Arrival time

Would you like us to organize your flights in Peru?

  Yes No
If yes, you must understand that we will pick you up at the airport in Lima and we will take you to a hostel and next day we will take you to the airport for your flight to Cusco where we will pick you up and take you to your final accommodation in our residence.
£ 33.00 must be added for transfer and hostel (1 night) in Lima.
Flight tickets may vary according to season, we will inform you about prices.
If no:  
Arrival date to Cusco (dd/mm/yy)
Airline
Flight number
Arrival Time

Important information about yourself

Are you allergic? Yes No
Type of allergy (if yes)
Are you vegetarian? Yes No
Do you have a particular diet? Yes No
Type of diet (if yes)

Emergency contact

In case of emergency, who should we contact to?
Name
Relation to you
Phone
City State/Province
Country
E-mail
Coment / request:  

Please check your information then click SEND

   

Thank you for registering your electives at Mundo Verde!!!

Mundo Verde Spanish 2008 - 2010
Phone: +51 84 274574 - info@mundoverdespanish.com
COVIDUC H-14 - San Sebastián
Cusco-Perú
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