Booking Form

1. Personal Details

Title:

Please select Mr Mrs Miss Ms

 

First Name:

Surname:

Date of birth:

Nationality:

Passport Number:

Job or occupation:

Home Address:
(in your country)

Telephone:

Email:

Fax:

Mobile Phone:

Level of English:

Please select Advanced Intermediate Low Intermediate Elementary

 

2. Course Applied For

General English:

Academic Year Course

Term/Partterm Course(s)

Summer Course(s)

Private Tuition

Specialist Courses:

Combination Course A (standard)

Combination Course B (intensive)

English Plus (please specify below)

Individual Specialist Course

Closed Group Course (please specify below)

Please Specify Your Course Choice: (if required)

Course Dates:

From

To

3. Accommodation

Do You Require Accommodation?

Yes

No

Type or Accommodation:

Homestay Family: Single Room Hotel Shared Room Guest House With private bathroom facilities ** Other (please specify)

If other please specify:

** Please note that these facilities are in short supply and cannot be guaranteed.

Do You Smoke?

Yes

No

Will you bring your car to England?

Yes

No

Do you want us to arrange airport collection / transfer at extra cost?

Yes

No

Do you have any health problems or allergies?

Yes

No

Please specify your health problems or allergies:

Do you have any special dietary requirements?

Yes

No

Please specify your special dietary requirements:

4. Payment & Next of Kin

£150 deposit (which includes £75 nonreturnable registration fee) must be paid when you book your course. The balance of fees is payable before or when you start. For details of payment methods please see How to Pay and our Terms & Conditions.

Payment Method

Domestic bank transfer (preferred method of payment)

International bank transfer

UK bankers cheque

Travellers' cheques (in Sterling (GBP))

Name and Address of Next of Kin (Person to contact in an emergency)

Title:

Please select Mr Mrs Miss Ms

Name:

Home Address:
(in your country)

Telephone:

Email:

Mobile Phone:

 

Comments

Any notes or comments:

Submit Booking