Register to Learn the Spanish Language

To register, simply fill in the following form, then return it here on-line, by mail, fax, or call us with your registration information.

Please advise us of your flight date, airline, number and arrival time so that we may be at the airport to meet you (if you do not yet have this information, you may send it to us separately at a later date). Extra fees apply for airport pick ups, please inquire.

** Please see the National Holidays listed at the end of this form before submission.**

Click here for VISA REQUIREMENTS

Fields with asterisks are required *

*NAME:
*EMAIL:
*ADDRESS Street:
City:
State/Province:
Postal code:
*TEL. #:
FAX #:
*AGE:
<< Minimum age 18 >> To register for the Teen Spanish Summer Adventure Program, click here
MALE: FEMALE:
*COUNTRY:	SELECT>> United States Canada Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovi Botswana Bouvet Island Brazil UK Indian Ocean Terr Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Repu Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Terr Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard & Mcdonald Isl Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Democratic Republic Republic of Korea Kuwait Kyrgyzstan Lao Democratic Repub Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiri Liechtenstein Lithuania Luxembourg Macau FYROM Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Isl Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevi Saint Lucia Saint Pierre and Miq Saint Vincent Grena Samoa San Marino Sao Tome and Princip Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa S. Georgia Sandwich Spain Sri Lanka Sudan Suriname Svalbard and Jan May Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Isl Tuvalu Uganda Ukraine United Arab Emirates United Kingdom US Minor Outlying Is Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Islands (Brit Virgin Islands (U.S. Wallis And Futuna Is Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe
PROFESSION:
PASSPORT NUMBER:
Which website, agency or other source did you find INTERCULTURA through?
*Internet sources:	SELECT>> costaricareisen.com csun.edu dahlke@die-reise.de die-reise spanishschulen edudirectories elpizote.com espotting.com eurolingua go abroad GotoEd ibw.com IE International intercultura.com langart.net lango language learning net languagepilot.com Language Skills Abroad latinamericalinks.com planeta.com planet edu schools-worldwide.com SLSLA sprachedirekt sprachkurse-weltweit.de spanish4student spanishcourses.info spanishstudies.com spanishstudyholidays.com Steve Tash students traveller.com Studyabroad Links studyabroad.com study-spanish.com Tico-deutsch Transsitions abroad Websbiggest.com World Wide Classroom None of the above
*Print and Media Sources:	SELECT>> Foot print Handbooks IE International Itchy Feet magazine Language Travel Magazine Let´s Go Guides Lonely Planets Guidebooks Nature Air Tico Times Papers Tico Times Costa Rica Guide Transitions Abroad Magazine None of the above
Other:
PICK ME UP AT THE AIRPORT:	YES: NO:
	DATE: ... TIME: AIRLINE FLIGHT#: WHICH AIRPORT: SELECT>> SJO/San José LIR/Liberia
LENGTH OF PROGRAM DESIRED FOR BOTH CAMPUSES (weeks):
NOTE:  Class  dates should start on a Monday and end on a Friday.     Homestay dates should be Sunday to Sunday, unless requesting additional days at the end of your stay (extra cost per night)
Classes date in Heredia  (Main Campus)  From:	...
To:	...
Classes date in Samara (Main Campus) From:	...
To:	...
SPANISH LEVEL:	COMPLETE BEGINNER: (no previous Spanish study) MID-BEGINNER: (present tense, simple sentences, basic comprehension) INTERMEDIATE: (future, past, present tense, some conversation) ADVANCED: (subjunctive, reading, writing, conversation)
WOULD YOU LIKE A HOMESTAY?:	YES: NO:
Start  in  Heredia Homestay  from:	...
To:	...
Start  in  Samara Homestay   from:	...
To:	...
IMPORTANT NOTE: Students who reserve a host family in either campus and then cancel their stay with less than 2 weeks notice will be subject to a penalty fee of $50. This applies both to 'no-shows', and to students who decide to stay at one campus instead of moving to the other campus as initially planned. For example: if you book 2 weeks in Heredia followed by 1 week in Sámara, but during your time in Heredia decide to stay there and cancel your stay in Sámara, you will be charged the $50 homestay-cancellation penalty.
NOTE: If you would like to guarantee your place in the beach campus, please register now for your beach dates. If you do not do so, you may still attend, but on a space- available basis.
Would you like to be the only foreign student in your family?:	YES: NO:
If you would prefer one of the HOTEL OPTIONS in Playa Sámara, please indicate which one in the notes below (ie. 2 or 3 star option, single or shared room). Please state any preferences you might have regarding your homestay (children, pets, smoking, vegetarian food, etc) and any relevant physical concerns we should be aware of.  In addition, in order to help us match to a homestay suitable for you, of the following five characteristics, please list the two which are most important to you:  · Cleanliness and standard of accomodations  · Communication and interaction with family  · Family that lives close to school  · Family with children  · Quantity and quality of food/cooking
ADDITIONAL COMMENTS:
* Emergency contact Number: * Emergency contact Name: I have read and agree to abide by Intercultura's Cancellation and Refund Policy (click here to read): * YES:

IMPORTANT:

Students who request airport pick-up must wait for their families at the airport exit point. If you cannot find your family, please use the emergency contact numbers you have to call the family and/or the school. Do not take a taxi or leave the airport until you have spoken to a school representative or the family. The school will not reimburse students who leave the airport without waiting for their family or contacting us first. You can make a collect (reverse charge) call by dialling 110, or you can ask the taxi drivers to change a small bill into local money in order to use a payphone. Alternately, we suggest renting a cel phone before you leave home, at www.costaricacellularconnection.com or a similar company.


If you would like to rent a cel phone for use in Costa Rica, click here

Please make sure that spanish@interculturacostarica.com and info@samaralanguageschool.com are included in your list of accepted correspondents (White List), so that your spam filter does not reject our emails when replying to your correspondence.

CREDIT CARD NUMBER: Please call or mail Samara Language School your credit card information in order to guarantee your reservation. Nothing will be charged to your card until you arrive, or in the event of a no-show. (info@interculturacostarica.com)