Educational Trip to Spain Enrollment Form

Travel dates: June 12-22, 2023

IMPORTANT:
Once you complete this enrollment form, please submit your non-refundable $500 deposit check payable to Mississippi College. If you enroll prior to Oct. 31, your deposit is $400.

Submit in person: Continuing Education (213 Nelson Hall) OR
Mail deposit to: Continuing Education, Box 4031, Clinton MS 39058.

Please include your name and EDU Spain 2023 on the reference line on your check.

If you would like to pay with a credit or debit card, please email Beth Stapleton (stapleto@mc.edu) for those details.
NOTE: paying electronically will incur a 5% surcharge for each payment.

Submission date:

Do you prefer 3 hours of graduate credit or 5 CEUs for this trip?

Do you already have a passport? (YES or NO)

If you already have a passport, please upload a copy of your passport picture page. IMPORTANT: you must have at least 6 months of validity left on your passport. (For this trip, it must expire after December 2023. If not, you will need to renew your passport)

Official Passport Name (First, Middle, Last). *NOTE: if you do not have a passport and need to apply, this will be your name on your social security card. The application for your passport should be done prior to December 1, 2022.

Birthdate:

Mailing Address:

Country

Street

City

Region

Postal Code

Best contact phone number (include area code):

Email address:

Gender (needed for rooming information):

Do you need to fly on the group flight or will you arrange your own airfare?

Please confirm rooming choice on tour (SINGLE + $900) or (DOUBLE):

For DOUBLE: list name of roommate:

Please list any special accommodations that you might require for the trip e.g. food allergies, physical limitations, etc.