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Language Course Application Form

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SUMMARY


 

 

  SECTION 1. PERSONAL DETAILS

 

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Fill in the application form on-line. Please answer all

          questions. All fields marked with a * are required and

          must be completed

 

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Once your application has been received you will be given

          a reference N that you will need to quote on all

          correspondence, e-mails or when contacting us by

         telephone

We offer on-line secure credit card

payment. We also accept cheques and

bank transfers.

 

First Name*

Last Name*

D.o.B.*

Age:*

Gender:*

Home Tel N  (country code first)

-

Work Tel N  (country code first)

-

Mobile Tel N  (country code first)

-

Fax N (country code first)

-

E-mail

Address Line 1*

Address Line2

City*

County/State*

Zip/Postal Code*

Country*

Next of kin (if different from above) Address Line 1:

Next of kin Address Line 2:

Next of kin City:

Next of kin County/State:

Next of kin Zip/Postal Code:

Next of kin Country:

Next of kin Tel N: (country code first)

-

Marital Status*

Present Employment:*

What is your mother tongue?*

Do you speak any foreign languages?

Nationality:*

Do you: Smoke?*

 

Choice of country:*

Choice of city:*

Date course starts:*

Date Course ends:*

N of weeks required:*

Course N:

Type of course required:

How do your rate your current level of the language?*

Have you already attended a language course through our agency?*

  SECTION 2. ACCOMMODATION

Choice of Accommodation:*

In a private home:

Single Room Double Room:

 

In a hotel: (Paris, London)

 

Category without private bathroom:

Single Room:Double Room:

Category with private bathroom:

Single Room: Double Room:

In a student residence: (Oxford)

Single Room:Double Room:

Other useful information: (allergies, particular diet etc)

Do your intend to travel by car? (parking cannot be guaranteed):*

 

  SECTION 3.SPECIAL SERVICES

When possible would you like to receive details about your journey? *

Would you like to receive information on insurance?*

How did you find our web site?*  Please quote Ref N if applicable:

By clicking "Continue", I agree to be bound by

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Conditions

 

 

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France

 

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Ireland

 

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Great Britain

France

 

Germany

Ireland

 

Italy

 

Spain

Switzerland

 

USA

Japan

 

 

 

Spain

Switzerland

 

USA

Japan

 

 

 

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