Registration Form

We'll get in touch with you within 12 to 24  hours.

Before filling out this form,
please read the following
very carefully. Click here

• give working stages at the end of the course
• offer student exchange
• help in obtaining student loans
• offer translation services
• give visas. For visas please go to the local consulate for the country your wish to go. Be advised that this process can be very long and does not guarantee that you will be allowed to travel to the country you want to go.

I confirm I read and approved the general enrolment conditions.

After clicking "SEND" below, we'll show you a confirmation sheet you'll be able to print and fax to our office.
On this confirmation sheet, you'll be able to write your credit card number and all information required for the payment.
A copy will be send by E-Mail to the address shown below. Please be sure you'll have access to this E-Mail address.
It's up to you to choose this copy as your confirmation to be faxed to our office.

Fields in Red are required

Applicant's name	Name First name Date of birth Day 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 Month January February March April May June July August September October November December Sex: Man Woman Mother tong Nationality Address City State Postal code Country Phone Fax Email
Person to contact in case of emergency	Name Address Phone
Accommodation	Accommodation None Single Family Accommodation Double Family Accommodation Single Residence Double Residence Single Studio apartment Apartment 1 single room Apartment double occupancy Hotel For family accommodation, please choose the following options: Young children ? Yes No No preference Pets ? Yes No No preference Do you smoke ? Yes No Do you accept smokers ? Yes No Number or meals per day No meal 1 meal per day 2 meals per day 3 meals per day If necessary, please indicate any details (likes, dislikes, allergies, special requests) that allow us to better choose your hosts N.B. Hosts taking students are not always "families" and are not required to include their guests in their social and family life. However, this type of accommodation give the both parties the possibility to exchange for a more complete immersion Starting date Day 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 Month January February March April May June July August September October November December 2008 2009 2010 Ending date Day 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 Month January February March April May June July August September October November December 2008 2009 2010 Lengh of stay 1 week 2 week 3 week 1 month 2 month 3 month 4 month 6 month Other Number of lessons per week Programme number (if applicable)
For your programme	You consider yourself to be: Beginner Elementary Intermediate Advanced Excellent Level of education: Secondary College University Your present occupation Your preferred sports and hobbies Please indicate any special requests you may wish (arrival greetings, extension arrangements, transportation, hotels, hosts....) Voyages Université cannot guarantee you'll obtain all your requests but assures you of its full cooperation Airport transfer: Yes No Arrival airport Airline Flight number Local time of arrival Date of arrival
Important information for your family accommodation	If you don't wish the offered transfer, please indicate the approximate time and date of arrival in the family: N.B. Programs for professionals, executives and commercials: Please send us a letter explaining your expectations. This letter will be sent to the school.
Destination City  wished for
Travel Agency	If you are a travel agency, please enter you Name / Agency / Address / Tel / Fax / Email below. Thank you.
Message
Credit Card Deposit Required	Name on Card: Credit Card: visa master card american express diners club Credit Card Number: Expiration: 01 02 03 04 05 06 07 08 09 10 11 12 / 2008 2009 2010 2011 2012 2013 2014 2015 SSL Certificates Payment Secured: read attached notes If you would rather talk with one of our agent and don't want to send your credit card information via this form, please you call us directly. We would then proceed with your inscription
Signature	I authorise Voyages Université to debit my credit card above for the 300 $CAN or 600$ CAN depending of the condition. (see general conditions) .
Conditions	I confirm having read and approved the general inscriptions conditions.
Code
Verification	Capture the 4 letters in the image above before you click Send Registration Form. Code :