Contact Information:

• Last Name:     First Name:     Title: Mr. Mrs. Ms. Dr.
  
  
• Complete Mailing Address(street, suite, city & postal code):
  
  
• Home Tel:    Bus. Tel:    Email:

About Guelph Teacher's Needs:

• Occupational Background: (knowing this enables us to better customize the activities during immersion):   Elementary Teacher High School Teacher University/College Teacher Other
• Which level of French do you believe best describes you?    1. difficulty speaking in a simple conversation 2. comfortable speaking in a simple conversation 3. difficulty speaking in a complex conversation 4. comfortable speaking in a complex conversation
• What is the preferred month for your stay?   July     August

About you:

• Please list some of your hobbies & interests:
• Where did you hear about us / our Program?:   Internet Newspaper Our Website Friends / Family Other

Health information:

• Contact person in case of emergency: (include full name, address, telephone number(s) and email):
• Relation to you:

Securing Your Space:

COST: $480.00

• I am paying now by Paypal to secure my space   Yes
• I am paying now by Email Transfer to secure my space   Yes
• I am Mailing my payment to you    Yes

I understand there are limited spaces and my space is not secured until full payment is received Yes

Other Questions/Comments: 

** Note: There is a non-refundable charge of $50 for administration charges for any cancellations less than two weeks (14 calendar days) from the class start date. There will be no refund after the start date.

** The PAYPAL button will open your payment screen in a separate window. Once you have confirmed your payment, please DO NOT FORGET to return to this screen and press "Send Now" to complete your registration.

    

*** If you are having trouble sending, please try a) to reset your privacy settings as they may be too strict and/or b) opening this webpage in a different browser - ie: firefox or explorer.
**** If this still fails, as a last resort only, fill in the information on the form directly in the browser, print (control 'p') and fax to us at 1-519-763-2239