BOOKING FORM

Please read the terms and conditions

(Use the "Back" button on your browser to return to the previous page)          

Click here to return to home page

 

Please enter the details requested below and click on "Submit" to return the form to us.

Please select your language and school

If you have selected "Other" - which language and city would you prefer?

PERSONAL DETAILS

Title: Mr Mrs. Ms.

First Name:
 Family Name:

Sex:             Male Female

Marital Status

 Married     Single     Other

Date of Birth:    Day: Month: Year:

Nationality:
 Mother Tongue:

Profession/Studies:

Home Address (Street):

 

City:

Zip/Post Code:

 

Country:

 

Telephone - Country Code

Area Code

Telephone (Home):

Telephone (Work):

Facsimile:

E-mail Address

 

 

Confirm E-mail Address

 

   

Passport Number:

    

Contact person in case of emergencies:

Name

Phone Number

How did you hear about us?

    

If "other" please  specify:

    

Did you use a search engine?

I

 
Why did you choose our school?

 

     
COURSES:    
I wish to enrol in the following courses:    

Course Title:

    

Course No: 

     

Start Date: Day:

 End Date: Day  
Month: Month  
Year: Year  
Total Weeks:    

If you cannot find a course code or title, please describe your course here:

e.g. "Intensive course - 4 hours per day"

MY LANGUAGE LEVEL:

  
Have you already studied the language? No Yes  
If 'Yes' please complete the following:    
University/School:  
Street:  
Zip/Post Code:  
City:  
Self evaluation:  
*Listening comprehension
*Reading comprehension
*Oral expression
*Written expression
   

MY ACCOMMODATION:
I would like the school to provide accommodation: No   Yes

If 'Yes' please complete the following:

Room type: Single Double
 Board# Breakfast Half-board Full Board Self Catering
Family    
Residence*
Apartment 

Hotel

# Residences and Apartments - no meals supplied - check for self catering facilities

*Available only in some locations

Other, please give details

Do you smoke? No Yes
Do you have any allergies? No Yes
If yes please give details
Do you need a special diet? No Yes
If yes please give details

Do you need a transfer? No Yes
If 'Yes' please give details:   

Arrival Date: Day
Month
Year
Arrival time:
Arrival location:
Flight Number:
Train Number:

Special requests/observations:

 

HOW TO MAKE PAYMENTS

Payment may be made by:

1    Certified cheque or draft and posted to:

Learn Languages Abroad Limited      
"Sceilig",
Ballymorefinn,
Glenasmole,
County Dublin,
Ireland.

2    Direct transfer to the following account:

Name of Bank NATIONAL IRISH BANK LIMITED
Bank Sorting Code 95 - 15 - 01  
Bank Address 27 College Green, Dublin 2. Ireland.
Account to be Credited Learn Languages Abroad Limited  
Address: "Sceilig", Ballymorefinn, Glenasmole, County Dublin, Ireland
Swift Code NIB KIE 2D
Account Number: 01323938

3    By Credit Card. (Access or Visa only)

Card details should not be sent by email for security reasons.

You can send the details by Fax to +35314511636:

The following details are required:
  • Card Type (Access / Visa)
  • Card Number
  • Name of Card Holder (as it appears on the card)
  • Date of Expiry
  • Amount of the Payment
  • Signature of Cardholder

(You may wish to print this form for you records and for payment details before submitting it)

 

Please enter the characters you see in the image: Image verification  Why?

If you cannot read the image, click for a new one 

Last revised: May 17, 2007

This form and its free FormMail processor supplied by www.tectite.com, creators of software copy protection.