1. Basic Information

First Name
Last Name
Birth Date
Nationality


2. Contact Information

Email
Phone
Profession
Hobbies


3.Emergency Contact

Emergency Contact
Telephone


4. Previous Knowledge Of Spanish:

Basic (A1)BASIC (A2)Independet (B1)Independet (B2)Proficient (C1)Proficien (C2)


5. Would you like to discover Galapagos while you learn Spanish?

Select a Program

SPANISH LESSONS & 10 DAYS TOURSPANISH LESSONS & 8 DAYS TOURSPANISH LESSONS & 7 DAYS TOURSSPANISH LESSONS & 5 DAYS TOURSONLY SPANISH LESSONS


6. Date You Wish To Begin To Study:

Date


7. Do You Wish To Be Met At The Airport In Baltra? (It will cost you $50 dollars to pick you up at the airport or $25 at the Chanel Itavaca)

Fly Date
Airline Company
Flight Number
Time of Arrival


8. Do you have any question or special needs?