Classes for Children Registration Form

Student Information
First Name:
Last Name:
E-mail Address:
Phone Number:
Address:
City:
State:	Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory
Zip Code:
Group Course Information
Calendar :	Select 9 Week Calendar Winter II Feb. 11–Apr. 14, 2008 Spring 2008 - April 21-June 23 Summer 2008 - June 30-September 6 Fall 2008 - September 8–November 10 Winter I 2008-2009 - Nov. 17–Dec. 20 & Jan. 5–Feb. 7
9 Weeks Courses :	Select Courses Initial & Intermediate - $380 bilingual children - $380 Advance Placement Test - $420
Private Course Information
Private Instruction:	# of lessons 5 Lessons $110 15 lessons $105 25 lessons $100
Semi-Private Instruction:	# of lessons 5 Lessons $70 15 lessons $65 25 lessons $60
Payment Information
Make check payable to: Queen Sofía Spanish Institute OR enter your Credit Card info
Credit Card Type:	American Express Visa Mastercard Discover
Card Holder's Name:
Credit Card Number:
Expiration Date:	1 2 3 4 5 6 7 8 9 10 11 12 Month	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day	2008 2009 2010 2011 2012 2013 Year
Card Identification Number:

How did you hear of us?:	Select ... Internet New York Times NYTimes.com New York Observer Wall Street Journal The radio Our Town West Side Spirit Friends, family, colleagues

Classes for Children Registration Form

Student Information

Group Course Information

Private Course Information

Payment Information