English Language Program
Order Form

Yes I want to learn english in USA in an American University!

First Name:

Last Name:

Gender:

1. Male
2. Female

E-mail:

Address:

City:

Province/State:

ZIP/Postal Code:

Country:

Telephone:

Fax:

Your nationality:

Preferred start date or month:

Length of study:

4 weeks
8 weeks
Longer than 8 weeks

Budget, including tuition, meals and lodging but excluding travel costs:

Less than $1500
$1500 to $3000
$3000 to $4500
Over $4500

I prefer a campus size:

Small (up to 1000 students)
Medium (1000 to 5000 students)
Large (over 5000 students)

Preferred Location:

New England
Atlantic States
South
West Coast

Northwest
Midwest
No Preference

I'd like to order:

ELP Program $350
Continuing Support $100 per hour

Payment

Amount: US $

Credit Card

: VISA MasterCard / EuroCard
Diners American Express

For credit card payment:
Card holder:

Card number:

Expires:
Month / Year

Travellers Cheques in US Dollars
Bank Draft in US Dollars
      Payable to
       American Universities Admission Program (AUAP)
Wire Transfer
      Contact AUAP for wiring information

Additonal comments

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AUAP American Universities Admission Program
5053 Ocean Blvd., Suite 19 - Sarasota FL 34242 -USA
Tel: (1) 941 346 1427 - Fax (1) 941 349 43 70 - e-mail: auap@auap.com
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English Language ProgramOrder Form

English Language Program
Order Form