Biduum Virginianum Registration
You will be notified as soon as possible after your registration has been received. You may pay for Biduum Virginianum through PayPal using the "Buy Now" button above this form, or by sending a check payable to SALVI to the following address:

Edie Barry
Treasurer, SALVI
1409 Lorraine Way
Santa Rosa, CA 95404

Tuition: $330.

First Name *
nomen
Your answer
Last Name *
nomen gentilicium
Your answer
Preferred Latin Name
nomen Latinum
Your answer
Email Address *
inscriptio electronica
Your answer
Mailing Address *
inscriptio cursualis
Your answer
Telephone Number *
numerus telephonicus
Your answer
Alternate Telephone Number
alter numerus telephonicus
Your answer
Institutional Affiliation (if any)
schola sive studiorum universitas
Your answer
Current Occupation
If you have been to other Latin immersion events, please list them here. *
If not, don't worry!
Your answer
Please rate your ability in speaking Latin. *
This will allow us to prepare the best possible experience for you.
Are you...? *
Esne...?
Age Range
(This question is optional but responses may be used to help better house participants.)
Requested roommate, if any
Contubernalis quaesitus/a
Your answer
Do you snore? *
Solesne stertere?
Do you smoke? *
Solesne fumum haurire?
Are you...?
Esne...?
Do you have any other special dietary needs or restrictions? Please describe.
Si aliud regimen ciborum tibi servandum est, paucis iam benigne adumbra, fusius de re alius disserturus.
Your answer
Do you have any medical conditions we should know about which might affect your comfort or safety during the workshop? Please describe briefly. (You will be asked to complete a more detailed questionnaire upon arrival.)
Si ulla valetudine afficeris de qua securitatis causa nos certiores fieri oporteat, eam quaesimus paucis iam adumbra, fusius de re alias disserturus.
Your answer
Emergency Contact *
Quis necessitate gravi convocandus?
Your answer
Would you like to receive occasional emails from SALVI about programs and resources? *
We promise to send only worthwhile information and never to clutter your inbox!
Submit
Never submit passwords through Google Forms.
This form was created inside of SALVI. Report Abuse - Terms of Service - Additional Terms