Language & Nature School of Southern Utah
PRELIMINARY QUESTIONNAIRE

NOTE: This form is currently having technical problems. Please copy the entire form (with CTL+A and then CTL+C in Windows) and paste it into an e-mail message (with CTL+V), mailing the requested information to AlohaLanguages@GeoCities.Com.
Thank you for your cooperation.

Please send the following information (as much or as little as you desire) to us, and we will put together a personalized program based on your needs. We will send you a detailed schedule, course and excursion description, price, and other needed information. If you prefer, you can write to us for more information in ENGLISH, FRENCH, GERMAN, ITALIAN, JAPANESE, RUSSIAN, or SPANISH. Or call us at 1-(435)652-3668.

We look forward to hearing from you soon!

PERSONAL DATA
Your name:

Likely number in your group:

Age range of group members:

E-mail address:

Complete mailing address:

City code & telephone:

City code & fax number:

GENERAL PLANS

Preferred course dates:

Earliest possible begin date:

Latest possible end date:

Estimated number of course days:

Would you fly into the Las Vegas Airport?
YES
NO

If not, how would you arrive at the school?

How would you prefer to travel from Las Vegas to the school?
rental car
van service
airplane
(NOTE: Van and air transportation can take you as far as St. George, where the school's staff can meet you. Or school staff can accompany you on tours of Las Vegas and on the interesting trip between Las Vegas and St. George.)

STUDY

Your English fluency?
beginning
intermediate
advanced

Special needs:

Type of studies desired (mark all applicable):

Specialized vocabulary needed:

Approximate percentage of study time:

Approximate percentage of excursions/practice:

ACTIVITIES

Please mark all activities for which there is interest:

Places you would like to visit (click here for descriptions):

Other activities/places for which you have interest:

LODGING

Please estimate the number of nights in:
Las Vegas (before and/or after course):
St. George (rental car needed):
Hurricane:

Please estimate the number of people in each type of room:
one king-size bed (2 max.):
two queen-size beds (4 max.):
two queen-size beds and a sofa-bed (6 max.):

Room price range preferred:
most inexpensive options
$30-45/night
$45-60/night
deluxe accomodations

Please check the features that you desire:

Other interests and needs: