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Language Course Application Form

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SUMMARY


 

 

  SECTION 1. PERSONAL DETAILS

 

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Print out the application form, fill it in . 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

 

 

Print out the credit card form and fax it to us on: +44 (0)870 1689892 together with the application form.  For your convenience if you prefer, you can send us your application form securely on-line. We also accept credit card payment over the phone, 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*

 

Next of kin Address: (if different from above)

 

Next of kin Tel N :(country code first)

 

Nationality:*

 

What is your mother tongue?*

 

How do your rate your current level of the language?* (please tick)

 

Fair:

Good:

   Poor:  

Do you: smoke?*

 

Date of arrival:*

Date of departure:*

Language course required:

 

4 days:

 5 days:

 

Sporting activities required (please tick)

 

Horse riding: 

Sailing:

 Skiing:

Tennis:

 

Other useful information: (allergies, particular diet etc)

 

 

   SECTION 2. ACCOMMODATION

Choice of Accommodation:* (please tick)

 

Host Family:

 Hotel:  

Residence:

 

SECTION 4. PAYMENT DETAILS

Pay to:

Totalnannies.com

Payment for:

Agency Fee for language

course and accommodation

abroad

Quantity:

1

Amount:

99.00

    I wish to pay for the registration fee by (please tick)

 Credit Card:    Bank Transfer:    Cheque: 

Signed:

Date:

 

 

 

Great Britian

France

 

Germany

Ireland

 

Italy

 

 

 

Great Britain

France

 

Germany

Ireland

 

Italy

 

Spain

Switzerland

 

USA

Japan

 

 

 

Spain

Switzerland

 

USA

Japan

 

 

 

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