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 legal@fiu.edu 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.