Bolivia Unlimited | Applicants

First Name *

Surname *

Date Of Birth *

Gender *

We ask about gender so as to optimise room assignment in our residence.

Email *

Mobile Number *

Please include your country code in front of your mobile number

Address *

City *

Country*

Level of Spanish *

When would you like to start learning with us? (the 15th of which month) *

When would you plan on leaving? (the 14th of which month) *

Anything else you think we should know (such as any medical conditions etc.)

Medical Confirmation *

Confirm that you have made us aware about any delicate medical conditions you may have. Please disclose any medical conditions you have in the text box above. As La Paz is at such a high altitude existing medical conditions may be exacerbated and so it is important to make us aware of your needs and requirements.
In the unlikely event that something goes wrong in Bolivia we would like to have the contact details of your next of kin.

Next of kin Name

Next of kin Phone Number

Please include country code

Upload your a picture *

Used to create your Bolivia Unlimited ID and helps us to recognise you at the airport

How did you first hear about the Bolivia Unlimited? *

All information you provide will be kept private and will not shared with any third parties

I accept the terms and conditions *

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