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Online Enrollment Form Study Package ---Select-your-intended-duration-of-study--- One Week Course (no host family) $425 One Week Course (with host family) $500 Two Week Course (no host family) $845 Two Week Course (with host family) $995 Three Week Course (no host family) $1150 Three Week Course (with host family) $1375 Four Week Course (no host family) $1440 Four Week Course (with host family) $1740 Five Week Course (no host family) $1800 Five Week Course (with host family) $2175 Six Week Course (no host family) $2160 Six Week Course (with host family) $2610 Longer than six weeks Name Mr. Mrs. Ms. Miss Dr. Date of Birth January February March April May June July August September October November December 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 19 Address City, State, Zip -- AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MO MN MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Country Occupation (opt) Nationality (opt) Phone Fax E-mail Spanish Proficiency ---choose-from-list--- Advanced Intermediate Beginner Zero Enrollment Dates (desired, if any) Start: Monday End: Friday How did you learn about "La Escuela De Idiomas D'Amore"?   Please complete the following form. Payment options will be available on the next screen. Questions? Comments? Email info@edcostarica.com Costa Rica Contact Info Escuela D'Amore: Apdo. 148-6350 Quepos, Costa Rica Tel/Fax: 506-777-1143   USA Contact Info: Escuela D'Amore 216 Tamoshanter Drive Palm Springs, Florida 33461 Tel:1-800-261-3203