click here to enroll online english | français | deutsch | dansk | italiano
 
Enrollment at Celas Maya
Any questions that you may have may be directed to us at celasmaya@gmail.com, skypename: celasmaya and info@celasmaya.edu.gt or you may use our contact form

FAIL (the browser should render some flash content, not this). FAIL (the browser should render some flash content, not this).


Complete the form below to enroll with Celas Maya. This page is secured using
High Level 256-bit SSL Encryption. All data transmitted is secure.
All fields are required.

Identifying Information


Enter your full name:


Street Address:


City, State/Province, Postal code:


Country:


Nationality (if different):


Date of birth:
Day: Month: Year:

Phone number:


E-mail address:


Requested study start date (ex. 3 April 2005)


Planned weeks of study:

Additional Information

Language you will study:
Spanish Quiche / K'iche

Describe any previous experience with this language:

Describe any special areas of study on which you want to
concentrate:

Describe any preferences concerning your family homestay; e.g.
pets, children, smoking:

Describe any special dietary requirements:

Describe any allergies or medical conditions of concern:

Please provide emergency contact information. At a minimum,
include name, telephone number, and relationship:

1.How did you find out about Celas Maya:
On the internet Friend/Email/Word-of-mouth Other

2. What can we do to make our website more informative/easier to
use:

Credit card information for the US$30 registration fee.
Please note that at this time we can only accept payment by VISA -- we cannot
accept MasterCard or American Express. Because of fees imposed by our bank,
a US$3 processing fee will also be added to your registration fee.
Total charge: US$33

Name on VISA card:

Billing phone number:

Card number:

Expiration Date (e.g. 11/05):


Celas Maya process this form by means of staff and not computers. This is why you do not need to add your 3/4 didget security number.


The Thawte Trusted Site Seal is a visible, real-time assurance, that guarantees that the information you submit to our website is private.

The Thawte Seal informs you that this website is certified by the most trusted digital certificate provider on the Internet. Thawte is recognized world over as a premium certification authority.

By clicking on the Thawte Trusted Site Seal below, your will get real-time confirmation of the validity of the certificate on the Celas Maya web server.

If you are not comfortable with enrolling online, you may fax us the printable form at 502-7761-4342
© Celas Maya | zdesign