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Contact Information:
Family Name: First Name:
Phone Number: Fax Number:
Present Address: City:
State/Province/Prefecture: Zip/Postal Code:
E-mail (required):
Group or Organization (if appropriate):
Length of Program:

Dates and Location:
Desired Dates of Program:
Arrival Date: Departure Date:

Desired Location (please give at least 2 locations in order of preference):
1.)
2.)

Group Participants:
Is this inquiry for... A Group: An Individual:
If this is for a group, how many people?
Please give us the age range of the group... Age of Youngest: Age of Oldest:
Will there be an escort accompanying the group? Yes: No:

ESL and Excursions:
Do you want ESL lessons? Yes: No:
If so, how many hours per week (12 is average)?
How many full day excursions per week would you like (average is 1)?
How many half day excursions per week would you like (average is 3)?


Do you have any specific activities or excursions you would like to include? If so, please tell us:


Would you like any overnight excursions, such as camp, etc.? If so, please tell us:


Please let us know any special requests you may have:

Since each of our programs are custom designed, the cost of your program will vary depending upon the information you provide us. We will calculate the costs of your requested program based on this information. We require payment in order to confirm. Also, we request a photo and letter of introduction from each person for whom a homestay will be provided. Please let us know if your preferred method of contact is something other than e-mail. We can fax or mail you your request. We look forward to working with you to provide a quality homestay.

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