SMU Cox School of Business Online MBA Immersion - Santiago 2023

OMBA Immersion - Santiago, Chile
February 25th - March 2nd

Please use this form to register, select your accommodation preferences, and pay for additional nights and/or one guest package, if applicable.

The registration information is due by December 9th, 2022.

PLEASE CONSIDER:

If you are traveling with guests, use this form to register yourself and your guest(s).

For Payments, please follow these instructions:

If traveling with 1 guest: Please use this form to register and pay for 1 guest package.

If traveling with more than 1 guest: please contact your Program Manager Ellen Weathers, at ellen@southbridgeaccess.com to coordinate payment of guests.

Hotel

The group will stay at the Doubletree Santiago Vitacura. In order to accomodate early morning arrivals and late night departures, the group has guaranteed early check-in and late check-out.

Check in available from 7:00 a.m. on Saturday, February 25th.
Check out is until 11:00 p.m. on Thursday, March 2nd.

* For questions regarding this form or registration, please contact Ellen Weathers, program manager, at ellen@southbridgeaccess.com, Pamela Sotomayor at pamela@southbridge.com, or Brielle Read at brielle@southbridgeaccess.com.

* This information is completely confidential and will remain between Southbridge Access and Southern Methodist University. This form is secured by using an SSL.

Name as it appears on your passport

First NameMiddle NameLast Name

Preferred name

US Phone Number

Email

example@example.com

Gender as it appears on your passport

Nationality as it appears on your passport

Date of Birth

Passport Number

Passport Expiration Date

US Visa Information (if applicable)

Please list any dietary restrictions (allergies, gluten-free, etc.)

Do you have any health concern or anything you would like to let us know to better accommodate you during the program?

Emergency contact name

First NameLast Name

Emergency contact relationship

Emergency contact phone number

Emergency contact email

example@example.com

Will you be traveling with any guest(s)?

Traveling with Guest(s)

Students are welcome to bring one guest or guests on the trip.

The cost to add one guest to non-academic programming is US$ 444.00.

The guest package includes:

Upgrade to double occupancy room at the Doubletree.
Day trip to the Andes Mountains with lunch included on February 26th.
Dinner on February 27th.
Lunch and tour at vineyard in the Casablanca Valley on March 1st.
Airport transfers on February 25th and March 2nd.
Transportation to/from included activities.

*In case of travelling with more than one guest, please follow the instructions detailed at the begining of this form.

Please select your number of guests:

1 guest2 guests3 guests

(Guest 1) Name as it appears on passport

First NameMiddle NameLast Name

(Guest 1) Preferred name

(Guest 1) US Phone Number

(Guest 1) Email

example@example.com

(Guest 1) Date of Birth

(Guest 1) Gender as it appears on passport

(Guest 1) Nationality as it appears on passport

(Guest 1) Passport Number

(Guest 1) Passport Expiration Date

(Guest 1) US Visa information (if applicable)

(Guest 1) Please list any dietary restrictions or allergies

(Guest 1) Do you have any health concerns or anything you would like to let us know to better accommodate you during the program?

(Guest 1) Emergency contact name

First NameLast Name

(Guest 1) Emergency contact relationship

(Guest 1) Emergency contact phone number

(Guest 1) Emergency contact e-mail

example@example.com

(Guest 2) Name as it appears on passport

First NameMiddle NameLast Name

(Guest 2) Preferred Name

(Guest 2) US Phone Number

(Guest 2) Email

example@example.com

(Guest 2) Date of Birth

(Guest 2) Gender as it appears on passport

(Guest 2) Nationality as it appears on passport

(Guest 2) Passport Number

(Guest 2) Passport Expiration Date

(Guest 2) US visa information (if applicable)

(Guest 2) Please list any dietary restrictions or allergies

(Guest 2) Do you have any health concerns or anything you would like to let us know to better accommodate you during the program?

(Guest 2) Emergency contact name

First NameLast Name

(Guest 2) Emergency contact relationship

(Guest 2) Emergency contact phone number

(Guest 2) Emergency contact e-mail

example@example.com

(Guest 3) Name as it appears on passport

First NameMiddle NameLast Name

(Guest 3) Preferred Name

(Guest 3) US Phone Number

(Guest 3) Email

example@example.com

(Guest 3) Date of Birth

(Guest 3) Gender as it appears on passport

(Guest 3) Nationality as it appears on passport

(Guest 3) Passport Number

(Guest 3) Passport Expiration Date

(Guest 3) US visa information (if applicable)

(Guest 3) Please list any dietary restrictions or allergies

(Guest 3) Do you have any health concerns or anything you would like to let us know to better accommodate you during the program?

(Guest 3) Emergency contact name

First NameLast Name

(Guest 3) Emergency contact relationship

(Guest 3) Emergency contact phone number

(Guest 3) Emergency contact e-mail

example@example.com

Would you like to add nights pre or post program?

YesNo

Additional Nights

DoubleTree Hotel Santiago Vitacura

Extra night in single occupancy room: US$ 104.00 / night.
Extra night in double occupancy room: US$ 115.00 / night.

Note: If you are traveling with more than 1 guest and would like to add additional hotel nights to your trip, please contact Ellen Weathers to coordinate as rates may vary.

For questions regarding additional nights, please contact Ellen Weathers at ellen@southbridgeaccess.com.

*Please consider that additional hotel nights are subject to availability. If we cannot confirm your additional nights, you will be contacted directly and refunded for your selection.

When would you like to add the additional hotel nights?

Pre programPost ProgramPre & post program

Arrival Date

Please indicate the date you arrive to Santiago

Departure Date

Please indicate the date you depart from Santiago

Guest Package

OMBA Immersion Santiago: Guest Package

Pre Program Nights

Single Room OccupancyDouble Room Occupancy

Post Program Nights

Single Room OccupancyDouble Room Occupancy

Total

My Products

USDDescription

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Emergency Contact Information

(Guest 1) Information

(Guest 1) Emergency Contact Information

(Guest 2) Information

(Guest 2) Emergency Contact Information

(Guest 3) Information

(Guest 3) Emergency Contact Information