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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________________________________________

Have you traveled to Mexico before?  Y/N   Have you traveled to Oaxaca before? Y/N    If yes, when?

What is your level of experience or skills with the subject matter in the program you are registering for?  Please explain.

 

 

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?  Please explain.

 

 

Lodging Preferences for Workshops (except jewelry making)

Base Cost Double-Occupancy   $___________

Single Supplement, $____________ 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, amount $_______.

[    ]  Oaxaca cooking class, amount $________.

[   ]  Temescal in Teotitlan del Valle, amount $______.

[   ] Shiatsu massage in Teotitlan del Valle, amount $_________.

[   ]  Other______________________________

Total amount of program including any optional/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.  We will send you an invoice to make a payment with MasterCard, Visa, PayPal or Bank Draft.

How did you hear about the program?

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

Other__________________________________

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

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

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