On-line Spanish lessons registration form

Please fill out the form below for information or to apply to our on-line Spanish lessons. You will hear back from us very soon!

Note: You have to please enter a valid e-mail address to be able to submit the form:

Name*:

E-mail:*

Country*:

Telephone:

Gender:
Male Female

Age:

Dates you wish to study:

From:
To:

Time you wish to start your lessons (Ecuadorian time -5 hours GTM)

Current time in Ecuador is:

Hours per day:

Hours per week:

Level of classes:

Message, questions, comments or special requirements:

How did you learn about Simon Bolivar Spanish School?

Please specify:

Payment Options: Credit card (Mastercard, Visa, American Express or Diners) through:

Please feel free to contact us:

E-mail: info@simon-bolivar.com
Tel/Fax: (593-2) 223 4708, (593-2) 254 4558.
Quito, Ecuador

Thank you for choosing our school!