PRESHCO Site Visits

If you would like to visit the program, please fill out the form below. PRESHCO staff will be in touch with you regarding your request.

Name

As it appears on your passport

First Name

Last Name

Title

Institution

Date of intended visit

YYYY

Gender

Date of Birth

Country of Citizenship

Institutional Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Cell Phone

Country

(###)

###

####

Will you have cell service in Spain?

Do you have any conditions which may prevent you from climbing stairs or walking 1-2 miles?

Any dietary restrictions or food allergies?

Special medical, physical or health needs

Please state any accommodations that you would like us to be aware of

FOR CONTACT IN CASE OF EMERGENCIES

Name

First Name

Last Name

Relationship

Home Phone

Country

(###)

###

####

Work Phone

Country

(###)

###

####

Cell Phone

Country

(###)

###

####

Name

First Name

Last Name

Relationship

Home Phone

Country

(###)

###

####

Work Phone

Country

(###)

###

####

Cell Phone

Country

(###)

###

####

Is there anything in particular you hope to accomplish on this visit that is not described in the Site Visit document? If so, please describe below.

Do you wish to visit any PRESHCO classes?

All courses are delivered in Spanish.

Do you have plans to travel to other areas of Spain or Europe before or after the site visit?