Application form for a language course in abroad by fax

Language Course Application Form

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SUMMARY

SECTION 1. PERSONAL DETAILS

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

questions. All fields marked with a * are required and

must be completed

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 SSL on-line secure credit card

payment. For your convenience if you prefer, you can fax us

your application with your credit card details. We also accept

credit card payment over the phone, 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:

SECTION 4. PAYMENT DETAILS

Pay to:

Totalnannies.com

Payment for:

Agency Fee for language

course and accommodation

abroad

Quantity:

Amount:

£ 99.00

Payment for:

Registration Fee

Amount

£ 43.00

Total to be debited to credit card

£142.00

ENTER YOUR CREDIT CARD INFORMATION

Your information will be kept secure and private

First Name*

Last Name*

Type of Credit Card*

Credit Card Number*

Issue Number (only Switch Cards)

Expiration Date*

Billing Address Street*

Billing Address City*

Billing Address County/State*

Billing Address Postal Code/Zip*

Billing Address Country*

For your protection, we confirm credit card billing addresses.

The process normally takes about 30 seconds, but it may take

longer during certain times of the day. Please DO NOT cancel

your submit request until you have received a final response

from the server.

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

totalnannies.com's conditions

Conditions

1) The agency fee is £99.00. It is inclusive of all expenses. The fee is payable on application. 2) In the event of cancellation or failure to arrive on your part, the agency fee will under no circumstances be reimbursed. 3) If we are unable to satisfy your application the entire fee will be reimbursed. 4) Whilst every precaution is taken with the presentation of clients, we decline any responsibility for unpredictable and unforeseen causes. 5) The course and accommodation fees must be paid to the agency at least 6 weeks prior to the commencement of the course. When application is received less than 6 weeks prior to commencement of the course the amount due is payable immediately. 6) On application a registration fee of £43.00 is due (non refundable) 7) At the beginning of the course every student must produce receipt of payment. 8) The address of the accommodation will be communicated about 2 weeks after registration but not before 3 months from commencement of course. 9) Delay in the payment of fees due can result in cancellation of registration. 10) Cancellation of registration must be notified at least the Friday before the commencement of the course. In that case the whole course and accommodation fees will be refunded. The registration fee and agency fee is not refundable. 11) In the event of failure to arrive at a course without notification as per point 10 or in the event of withdrawal from a course, or if you do not attend a course no refund will given on course fees. In the event of financial difficulties or serious health problems or an accident a refund will be at the discretion of the college. However course fees for a Year of Academic Study are not refundable under any circumstances. 12) If you leave your accommodation after the start of a course, 2 week’s notice is needed (finishing Saturday). 2 week’s rent can be paid instead of the notice. The rest of the accommodation fee will be refunded. 13) Participants are not insured for illness, injury, theft or loss of personal belongings whilst attending the college or in a family home. It is advisable, therefore to undertake a private insurance. totalnannies.com can assist you in this. 14) The school is usually closed during local and national holidays.


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