Legal Studies Institute - Florida International University

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Legal Studies Institute
Registration Form
Forma de Inscripción
STUDENT INFORMATION / INFORMACIÓN DEL ESTUDIANTE:
Name/ Nombre: ___________________________________________________________________
Social Security No. or Passport No
Numero de Seguro Social o Pasaporte: _______________________(Required by Federal Taxpayer Relief Act of 1997)
Address/ Dirección: ________________________________________________________________
City/Ciudad: __________________ State/Estado: ________ Zip code/Codigo de Area: ___________
Phones/Telefonos: (______)____________________
(_____)_____________________________
Email / Correo Electrónico: ___________________________________________________________
Program for which you are applying: ____________________________________________________
Registration options /
opciones para inscribirse:
How did you learn of our program?
Como aprendiste de nuestro programa?
Por correo:
_____
_____
_____
_____
_____
_____
Via Fax:
Via e-mail:
Florida International University
Legal Studies Institute
11200 S.W. 8 Street, RDB 2015
Miami, FL 33199
(305) 348-2030
[email protected]
Flyer / Brochure
Email from LSI
Newspaper / Radio
FIU Website
FIU Alumni Association
Professional Association
Teléfono: (305) 348-2491 Web: lsi.fiu.edu
PAYMENT OPTIONS / OPCIONES DE PAGO:
Amount / Cantidad de pago: $__________________
NO CASH /
NO SE ACEPTA PAGO EN EFECTIVO
Signature / Firma: ___________________________________ Date/Fecha: _______________________
Payment Type / Metodo de Pago:
Cashier’s Check or Money order No.: ____________________ (Payable to FIU / a nombr e de FIU )
Credit Card / Tarjeta de Credito: Visa Master Card American Express Discover
Name on card / Nombre en la tarjeta: __________________________________
Card No / No. de tarjeta: _________________________________ Exp. Date /Fecha de Exp. __________
Billing address / Dirección de Facturación: ___________________________________________________
The administration of the Legal Studies Institute reserves the right to modify, delete, cancel, add or change course
and seminar programs, tuition fee, classroom location, faculty and courses as deemed necessary.
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