Contact Information
First Name:
Last Name:
Email:
Region:
What would you like from CCUSA?
Would you like someone to call you to discuss the programs that you have read about and are nor interested in?
Would you like someone to send you our general promotional flyer or to receive updates via mail?
Do you have specific questions about the program you would like answered over email?
Phone:
Mobile:
Address line 1:
Address line 2:
City:
State:
Postal Code:
Country:
Questions:
Where did you hear about CCUSA?
--CCUSA Staff--
--Consulate--
--Friend--
--Info Meeting / Presentation--
--Internet--
--Job /Careers Fair--
--Magazine--
--Newspaper--
--Other--
--Poster--
--Radio--
--Referral From Applicant--
--Teacher / Lecturer--
--Travel Agent--
--TV--
--University--
--CCUSA Staff--
--Consulate--
--Friend--
--Info Meeting / Presentation--
--Internet--
--Job /Careers Fair--
--Magazine--
--Newspaper--
--Other--
--Poster--
--Radio--
--Referral From Applicant--
--Teacher / Lecturer--
--Travel Agent--
--TV--
--University--
Other:
Programs of Interest
Please select the programs you are interested in form the list below. Some programs may be offered by multiple offices. You can freely choose which office to submit your inquiry to.
CCUSA New Zealand
PO BOX 2494
Shortland Street
1140
Auckland
New Zealand
P:+64 (9) 930 1085
Fax:
Working Holiday USA
Work UK
Camp Counselors Russia
Intern USA
Camp California - Counselors
Work Experience USA [Winter]
Practical Training USA
Camp Counselors USA
Camp Counselors UK
Camp Counselors Canada
By submitting this inquiry you will be automatically added to the CCUSA Newsletter recipient list.
