Booking a course

Course Dates:	Start Finish:
Number of weeks:	01 02 03 04 Extra nights: 0 1 2 3 4
Course:	General Business English Exam Preparation Young Learners
Lessons:
Number of hours	10 15 20 25 30
First Name
Surname
Age
Nationality
Sex	Male Female
Profession
Home Telephone Number
Mobile Telephone Number
Email Address
Home Address
Do you have any allergies?
Do you have any dietary requirements? (eg vegetarian)
Do you have any health problems or disabilities we should know about?
Do you smoke?	Yes No
If yes, would you be prepared to stay in a non-smoking household?	Yes No
Hobbies, interests, and any likes and dislikes you feel we should know about:
Is there anything else we should know about, or do you have any questions?
What do you think your level of English is?	Elementary Pre-Intermediate Intermediate Upper-Intermediate Advanced
Transport required on arrival?	Yes No
Transport required on departure?	Yes No
Arriving at:	Heathrow Gatwick Other
Other. Please specify:

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