Booking Form

Please complete this form. Due to limited enrollment,  DO NOT SEND A DEPOSIT  until we certify (by email, snail mail,  or phone) that space is available for you. If space remains, please make your deposit check or money order  to Dr. E. Barbara Phillips,  write Latitude in the memo portion of your check or money order.  Please send-- via snail mail -- a copy of  this booking form, signed and completed, together with  a check or money order deposit of $300 per person to  E. Barbara Phillips, 1043 Oxford St. Berkeley, CA 94707, USA.

This booking form cannot be downloaded and sent via computer at this time. 

Confidentiality: All information gathered here will remain confidential and only be used  for purposes of enrollment & accommodation during your participation at Latitude. Please notify us of any violations to this privacy. 

Course name(s) & date(s)

Name (s)

address


City                           State/Dept.    Postal code    Country

Phone                      Fax                       Email Address

ACCOMMODATIONS I wish to share a room with a family member or friend.
I am amenable to sharing a twin-bedded room with another participant whom I do not personally know.
I prefer single accommodations. If no single room is available, I will pay a single supplement for a room designed for two people.
I prefer to stay in Category A-Superior  or  B-Standard  lodging    (Please circle one)
I prefer to stay in a large gîte with friends who will be accompanying me.

Answers to the questions below will help us to better plan & to tell others about our program. Thanks for taking the time to fill this out!

While at Latitude, do you plan to rent a car   bike 
How would you describe your fluency in French?
012345 ( 0 = none  to 5 = native speaker)
How would you describe your fluency in English?
012345 

What is most appealing to you about this program?
Have you ever attended a short course? Yes No
    If yes, which one(s) (e.g., continuing education connected to work; sports, dance, or yoga course; Elderhostel;  Université de Troisieme Age)? 

Please alert us to any special conditions or needs that may require our attention (e.g., extra-long bed, allergies, phobias, dietary restrictions or preferences,  private bathroom).

How did you learn about Latitude  (e.g., surfing the Net; friend;former participant,  announcement in Francophile revue, college bulletin board)? 

PAYMENT SCHEDULE

For 2008:A  non-refundable deposit of  $300 per person by check or money order is due upon application/(which is the same as registration). Send a copy of this booking form (signed and completed)  via snail mail  and your deposit to Dr. E. Barbara Phillips. Please write Latitude in the memo portion of the check or money order.   All participants  must complete registration and payment by April 15, 2008.   .

Please note: Credit cards cannot be used at this time.

Those applying for stipends  must complete registration by January 15.

CANCELLATIONS & REFUNDS Cancellations are effective only upon receipt of your written notification. You will get a  refund--minus your non-refundable deposit plus an administration fee of $400 (or the euro equivalent)-- for cancelling up to 60 days before the course. If you cancel between 31-60 days before the course, there is an additional administration fee of U.S. $500. If you cancel 30 days or less before the course, you lose 100% of the costs -- unless your spot is taken by another participant. Please understand in advance: finding a replacement (particularly from the United States) is difficult within a few weeks as most people make their plans much in advance. We advise participants to purchase trip insurance to cover illness, etc.

If, for any reason, Latitude cancels your course, you get a full refund.

RESPONSIBILITY

Neither Latitude nor its staff is responsible for personal injury, accident, sickness, and/or loss or damage to personal property. We strongly recommend getting a package of insurance, including trip cancellation & medical insurance, before leaving home.
I confirm that I have carefully read & that I agree to the policy on refunds & the responsibility clause.

Signed _______________________________________________  Date__________________
 

    Lu et approuvé_________________________________________________Date_____________________
 

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______________________________________________________________________________________
Please send this form with  your deposit check or money order to Dr. E. Barbara Phillips,  Latitude  Director, E. Barbara Phillips  1043 Oxford St., Berkeley, CA 94707

Below is another questionnaire--- for those of you who would like to complete it .  Latitude cannot take credit for the questions; they were  assembled by Marcel Proust.


                 OPTIONAL QUESTIONNAIRE                      

                                           Questionnaire de Marcel Proust

                                                             
Le principal trait de mon caractère___________________________________________
La qualité que je désire chez un homme _______________________________________
La qualité que je préfère chez une femme  ______________________________________
Ce que j'apprécie le plus chez mes amis________________________________________
Mon principal défaut_______________________________________________________
Mon occupation préféré__________________________________________________
Mon rêve de bonheur_____________________________________________________
Quel serait mon plus grand malheur___________________________________________
Ce que je voudrais être  ___________________________________________________
Le pays où je désirerais vivre____________________________________________
La couleur que je préfère__________________________________________________
La fleur que j'aime_______________________________________________________
L'oiseau que préfère ______________________________________________________
Mes auteurs favoris en prose _______________________________________________
Mes poètes préfèrés______________________________________________________
Mes héros favoris en prose _________________________________________________
Mes héroines favorites dans la fiction _________________________________________
Mes compositeurs préfèrés _________________________________________________
Mes peintres favoris ______________________________________________________
Mes héros dans la vie réelle  ________________________________________________
Mes héroines dans l'histoire _______________________________________________
Mes noms favoris ______________________________________________________
Ce que je déteste par-dessus tout _________________________________________
Caractères que je méprise le plus ___________________________________________
Le fait militaire que j'estime le plus __________________________________________
La réforme que j'admire le plus _____________________________________________
Le don de la nature que je voudrais avoir _____________________________________
Comment j'aimerais mourir ________________________________________________
Etat présent de mon esprit ________________________________________________
Fautes qui m'inspirent le plus d'indulgence _____________________________________
Ma devise _____________________________________________________________
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