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Oaxaca Cultural Navigator LLC Program Registration Form

Please copy this form and save it as a Word document, complete it and send it to me as an attachment via email.  Thank you.  -Norma

Program Name__________________________________________

Program Dates (Month/Days)_______________Year _________

Instructor Name_________________________________

Your Name (Print)_______________________________

Your Home Address________________________________________

City_________________ State________ZIP____________

Email_________________________________________

Mobile Phone_______________________________________

Home Phone________________________________________

Base Cost Double-Occupancy   $___________

[   ]  + Single Supplement, add $____________ referenced in program description.

[   ]  You have the option of coming early and staying in for a day (or two or three or more) in Oaxaca City or in Teotitlan del Valle.  You may also like to add on days after the workshop is over.

Additional lodging in Oaxaca:   # nights_______, dates________Price per night: $125.  Total $_________    (# nights X $ per night)

Additional lodging in Teotitlan del Valle:  # nights ______, Dates________  Price per night:  $55.   Total $______ (#nights X $ per night)

Total additional nights in Oaxaca and Teotitlan _______ Total $______

Optional Events as specified in the program description:

[   ]  Teotitlan cooking class, $65 per person.

[    ]  Oaxaca cooking class, $95 per person.

[   ]  Temescal in Teotitlan del Valle, $45 per person.

[   ] Shiatsu massage in Teotitlan del Valle, $45 per person.

[   ]  Other______________________________

Total amount of program including any supplemental costs $_______

[  ] We prefer Payment by PayPal.   Please send me an email to tell me you intend to register in the program and we will invoice you.  You can make a payment this way with MasterCard, Visa or Bank Draft.

50% deposit is required to secure your registration.  If you register within 45 days of the program start date, full-payment is due upon registration.  Final payment is due and payable 45 days before the program start date.

How did you hear about the program?

[  ] Google search  [  ] Friend  [  ] Facebook  [  ] Twitter

Other__________________________________

Have you traveled to Mexico before?  Y/N   Have you traveled to Oaxaca before? Y/N

What is your level of experience or skills with the subject matter of the program you are participating in?  Please describe.

 

 

Spanish language level: [  ]  None  [   ] Beginner   [  ]  Intermediate   [  ] Fluent

Explain Spanish language  background and experience. (Note: Spanish language skills are not necessary for this program.)

 

 

What are your goals and objectives by attending?  What do you want to learn, experience, do or achieve by the end of the program?  Why do you want to attend?

 

 

Planned arrival date?_____________________

Planned departure date?__________________

Dietary preferences/restrictions:

 

Is there anything else you would like to tell us about you?

Please return this completed form by email and we will send you an invoice by PayPal.  Email: oaxacaculture@me.com