Welcome Madrid Enrollment Form

Please print out this form, complete it in legible handwriting or type, and sign 
and date the enrollment form at the end. Once completed, please send it by mail to:

In Spain:
Welcome Madrid
c/o Admissions
C/Juan Álvarez Mendizábal 83
Sótano Izquierda
28008 Madrid
Spain

In the USA:
Welcome Madrid
c/o admissions
131 11th Street, SE
Suite "B"
Washington, DC 20003
USA 

Or Fax to:

In Spain:
(34) 91-548-3160
In The USA:
Fax: +1 (775) 618-2689 

Application Deadlines:
Normally, we must receive a complete enrollment form and fees no later than 30 
days before the program starts.


1.	Personal Information

__Mr. __Mrs. __Ms. __Miss First Name: _______________ Last Name:_______________

Street Address:________________________________________________________________

Street Address (cont.): _______________________________________________________

City/Town: _________________ State/Province: __________ Zip/Postal Code: ______

Country: ___________________________ Telephone: +_____  (____)  _______________

Fax: [optional] +___(____)_______________ E-mail: [optional] __________________

Citizenship: __________________________ Passport No: __________________________

Date of Birth: ___/__/______ Native Language: __________ Other Languages:______
               DD/MM/YYYY
 
2.	Language Course Information

I am currently a(n): 
__ High School/Preparatory Student 
__ College/University Student
__ Post Graduate Student (Master/PhD/Other)
__ Interested Adult 
__ Professional ŕ Please enter your profession:	

Current Level of Spanish:
__ Zero Beginner
__ Elementary
__ Pre-Intermediate
__ Intermediate
__ Advanced

 
I would like to enroll in a:
__ Course Package (1,250 €)
__ Course only (600 €)
__ Pre-Intermediate
__ Individual Lessons
__ None of the above

For the period of:
__ Summer
__ Fall
__ Spring
__ None of the above

If you require individual lessons, please state number of hours per week: 
____ hours/week


3.	Accommodation/Lodging Information

Do you need accommodations? __ Yes __ No

If you need accommodations, please select all that apply:
__ Private Room
__ Shared Room
__ Private Shower
__ Private Flat
__ Meals Included

Do you smoke? __ Yes __ No

Do you like pets? __ Yes __ No

Do you mind children? __ Yes __ No

Do you have allergies to foods/animals/other?__________________________________

Do you require any special assitance? _________________________________________
_______________________________________________________________________________


4.	Arrival Information

Do you need airpot pickup (50 €)? __ Yes __ No

If so, your arrival date (dd/mm/yyyy): _________ Time: _______ Flight No.: ____


5.	Payment Information

How do you wish to pay for our services? __Credit card __Bank Transfer * 

If paying with credit card:

Credit Card No: _______________________ Expiration Date: Month ______ Year_____

Cardholder Name: ______________________________________________________________

Street Address:  ______________________________________________________________

City/Town:___________________ State/Province:___________ Zip/Postal Code:______

I authorize to charge the above credit card account: 
___ Course deposits only ___ the full payment due

* If paying by bank transfer:

Please send your wire transfer as follows:

  To: Welcome Madrid S.L.L.
  Bank: Caixa Galicia
  Address: Calle Andrés Mellado 108, C. P. 28008, Madrid, Spain
  Swift: CAGLESMM
  Account Number: 
  IBAN: ES63 2091 0605 8930 4001 5812


__ Please find enclosed a copy of the wire transfer for the application fee and 
deposits (or a full payment)

Comments:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________


6.	Agreement and Release

By signing this Enrollment Form, I certify the above information is complete and 
correct. I understand that my misrepresentation may result in my expulsion from 
the program without any refund. I acknowledge that the terms and conditions 
appearing on this site constitute part of my agreement with Welcome Madrid, 
including sections concerning responsibility, refunds, changes in dates, 
accommodations, courses and billing of the selected options. I have read the 
Agreement and agree to follow all of Welcome Madrid's procedures. This Agreement 
will be effective when my application is accepted by Welcome Madrid and shall be 
governed by the laws of Spain.


Applicant's Signature _____________________________ Date: _____________________


Please do not forget to make a copy of this completed and signed application for 
your records and enclose your payment of the application fee and deposits.

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