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Participant's Name:
Name of the legal guardian, if under 18:
Date of birth:
Address:
City:
State:
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Zip:
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Phone:
Fax:
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E-mail:
English skill level:
Intermediate
Advanced
Teacher
If already a Wizard student, book's title:
Wizard School Where Registered Now
:
Selected Program:
Cultural immersion Program - CIP (Semi Intensive)
Intensive Program- IP
One-on-One Program (Individual)
Duration:
1 month
2 month
3 month
1 week
2 week
3 week
Beginning date:
Form of Payment
:
Credit card the view
Credit card in 3 times
Bank transfer the view
Bank transfer in 3 times
.
Emergency Contacts:
Name:
Relationship:
Address:
City:
State:
.
Zip:
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Phone:
Cellular:
Fax:
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E-mail:
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Comments:
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