NURSING GUARANTEED ADMISSION Program Order Form

Yes I want to study Nursing in an accredited American Nursing School

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:

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

Less than $6000
$6000 to $10000
Over $10000

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:

Nursing Admission Program $500
Extra University $500/per university

Payment

Amount: US $

Credit Card

VISA MasterCard / EuroCard

DinersAmerican 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

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AUAP American Universities Admission Program
Member of ACE and NAFSA
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