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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 an * 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*

Date of Birth*

Place of Birth

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)

-

Nationality:*

What is your mother tongue?*

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

Do you: smoke?*

Date of arrival:*

Date of departure:*

Language course required:

Sporting activities required (to make multiple choices hold down the ctrl key)

Other useful information: (allergies, particular diet etc)

  SECTION 2. ACCOMMODATION

Choice of Accommodation:*

Host Family: Hotel: Residence:

 

 

 

Great Britian

France

 

Germany

Ireland

 

Italy

 

 

 

Great Britain

France

 

Germany

Ireland

 

Italy

 

Spain

Switzerland

 

USA

Japan

 

 

 

Spain

Switzerland

 

USA

Japan

 

 

 

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