Request Information (Detailed)

Full Name:
Email address:
Email address:(confirm)
Telephone Number:
*Minors: If you do not want to give your name, you can give your parents name and information. 
However, please let us know the age range of the person/s who will be taking the program. 
That will help us to provide the correct information to you
Your E-mail Address:

What type of program are you looking for?

Please provide as much information as possible.

Foreign Language Study Programs (All Ages):  100% Total Language Immersion; “Almost” 100% Total Language Immersion; Special Programs for Teenagers; Spanish in Miami

Cultural & LifeStyle Immersion: HomeStay Only (Separate Programs for Younger Students & Adults

Language/s you want to learn (if you are interested in Foreign Language Study)?

Country or City?

Country/ies  you want to go to?

The reason for foreign language study or cultural immersion?

Reasons?:  Business? School? Proficiency Exam? Personal Interest?  Other (please explain)?

Age/s of the person/s taking the program?  (information can be sent to parents of minors) or Senior?  Adult?  College Age? High School?  Middle School?  Other? _____

When will you travel?   (Year?  Month?  Exact Dates?  Do not Know?)

Background Information? (if you want to provide it)

Occupation / Title:

Business /School /Organization:

Address

City: State: Country:    

Zip Code:   Postal Code:

Personal Information? (if you want to provide it) 

Home Address:

Address:

City: State: Country:    Zip Code:   Postal Code:

Phone Numbers:

E-Mail Addresses, etc. of Other People who might be interested in our programs.

FLSAS

Box 430903, South Miami, FL 33243

Call : 786.216.7302

Fax: (888) 725-5382

 E-mail: info@flsas.com


©2010 Louise Harber

FLSAS /  Foreign Language Study Abroad Service