Get Started Name as it appears on your passport* First Last NicknameEmail* Birthdate* MM DD YYYY Nationality on your passport*Passport Number*Expiration Date of Passport* MM DD YYYY Spanish Language Proficiency Level* Advanced Intermediate Novice Zero Spanish Language Proficiency Scale (Low, Mid, High)* Low Mid High Please use the ACTFL Proficiency Scale to rank your proficiency level (WILL OPEN IN A NEW TAB: https://www.languagetesting.com/actfl-proficiency-scale)Have you ever traveled outside your home country?*YesNoDo you have a medical condition?*YesNoIf yes, please explain.*Are you a smoker?*YesNoSpecial Diet (please explain)AllergiesAre you an educator?*YesNoContact InformationPermanent Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Cell Phone*Home PhoneAbout YouSex*MaleFemaleOccupation*Employer*Emergency Contact Name* First Last Emergency Contact Phone Number*How did you hear about us?* Internet Search Language Latte Podcast Kid World Citizen Facebook Twitter Friend Other Other (we'd love to know who to thank)Program InformationCalendar Year in which you wish to study201820192020Type of Program* 2018 Hanal Pixán/ Día de Muertos/ Day of the Dead - November Trip Summer Program for Educators Travel Dates* Group 1: June 7- June 15, 2019 Group 2: June 22-June 30, 2019 Hanal Pixán: Oct 25-28, 2018 (extended visits available) There are two options of lodging where participants will stay during their trip. All of the prices for One World Trek programs are based on double occupancy, which means two people to a room with two beds. Single travelers are paired in twin or multi-share accommodation with someone of the same sex during the trip. If you wish to have a single room, let us know by clicking the “my own room” box, which will require an additional fee. In our home, Casa de las 3 Sirenas, we are happy to offer 5 bedrooms. One bedroom (queen bed plus single bed) has their own private bathroom. The other bedrooms (each with 2 beds) have a bathroom in which they share with one other room. We can also make arrangements for participants at a very nearby hotel, if you wish to have a private room and bath.Are you traveling with a companion?*YesNoCompanion Name*Will they stay in the same room?*YesNoWould you like to share a room with another teacher?*YesNoWould you be willing to share a bathroom with another teacher?*YesNoAdditional InformationPlease let us know if you would like to extend your time by arriving earlier or leaving later, and we can help to make arrangements.I have read and agree to the terms and conditions, and I accept the risks.* Yes Please read through the terms and conditions here: https://oneworldtrek.com/terms-conditions/ *WILL OPEN IN A NEW TABApplication Fee* Price: $100.00 Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Expiration Date Security Code Cardholder Name