All NRCSA program fees are in US Dollars. NRCSA welcomes participants of all nationalities from any country around the world.
1. Please complete and send to NRCSA, P.O. Box 1393, Milwaukee, WI 53201, USA.
2. A non-refundable deposit of $100 USD (applied towards the cost of the program) and non-refundable registration fee of $40 USD per person, per program, payable to NRCSA (Total of $140 USD).
NOTE: The registration fee of $40 is waived for NRCSA alumni who have taken a NRCSA program since January 1, 2000.
3. Register early. Add a $40 USD per person late fee if paying in full within 40 days of departure. Within 20 days, all payments must be made by certified check.
4. Credit Cards may be used for deposits (see "G" below). NRCSA's Fax is (414) 271-8884. NRCSA street address for overnight deliveries is 207 E. Buffalo St., Suite 610, Milwaukee, WI 53202, USA. Please send separate form for each school if taking multiple programs.
5. If you have any questions about the registration process please contact NRCSA at (414) 278-0631.
Please print
A.Name(s)__________________Sex____Birthdate________Citizenship____
Employer__________________________Occupation______________________
If student, school attending and year
Street:________________________________Tel. Home:_________________
Street address (not P.O. Box) where someone can sign for documents sent to you.
City/State/Zip:________________________Tel. Work:_________________
Email Address: ___________________________________________________
In Emergency, notify:_____________________________________________
(Name, Address, Phone)
B. BACKGROUND:_________________________________________________
Describe any foreign language study and/or travel experience.
Check appropriate level:
Beginner_____Post Beginner______Intermediate______Advanced______
C. LODGING:_____________________________________________________
Indicate preferences which will be matched when possible.
Single Room_______ Share Twin_______ Other Lodging________________
Yes Smoking_______ No Smoking_______ Either________
Yes Pets__________ No Pets__________ Either________
Yes Children______ No Children______ Either________
Special diet(At an additional cost and may not be available)_______
Hobbies Reading___ Music___ Cooking___ Sports___ Jogging___
Objectives Enrichment___ Academic Credit___ Job Related___
Are You Quiet___ Outgoing___ Frequent Traveler___
D. GOALS:_______________________________________________________
E. INSURANCE: Included for prepaid study dates. If you leave early/return
later and want to extend coverage, add $19/addl wk (or fraction) and advise
dates.
F. PROGRAM ATTENDING City____________________________
School____________________________Start Date(program)_____________
Start Date(lodging)_______________2nd Choice Program______________
Program(name from dates/fees______________________________________
Number Weeks attending____________Number hours day/week___________
Allergies/Health problems_________________________________________
How did you learn of NRCSA________________________________________
Social Security number____________________________________________
Options(see program for choices)___________________________________
Your Signature____________________________________________________
If under 18, a parent must sign also.
G. CREDIT CARDS
May be used for program deposit not final payment. Indicate card
VISA______ Mastercard______ Discover______ American Express______
Amount Charged $ _________________ Card Number (13 plus number):
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Expiration Date ___ ___ /___ ___ _
SIGNATURE (as on card) __________________________________________
PRINT name (as on card)__________________________________________
Conditions and Refunds please check here before registering. |