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Personal
Details
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| Family Name: |
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First Name(s): |
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| Email Address: |
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| Sex: |
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| Nationality: |
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| First Language: |
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| Street Address: |
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| City: |
State: |
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Postal Code: |
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| Telephone Number:
Passport No:*(required)
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Payment
method:: |
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Date
of Birth
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| Have you stayed in the U.K. before?: |
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| If Yes where?: |
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| When?: |
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| Have you heard of ELC English Language Courses before?: |
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| How did you hear of
us? |
Following a visit
to the U.K. |
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Through a Newspaper/Magazine
entitled: |
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By recommendation |
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Through a mailing |
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Through the Internet
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Through an agent |
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Course
Details
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| Please Indicate which course you have selected, kindly refer to our
list of courses: |
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| How many days/weeks/months?:
Please indicate
start and finish dates:
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| Have you studied English before?: |
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| If yes, where?: |
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| For how long?: |
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| What is your present level of English?: |
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Accommodation
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| Do you require Accommodation?: |
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| What type of Accommodation do you prefer?: |
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| Date you wish your Accommodation to begin: |
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| Number of weeks: |
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| Date
you wish accommodation to finish: |
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| Would
you like Airport transfers? |
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| Where
from? |
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| Do you smoke?: |
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Do you have any special
interests/hobbies/sports?:
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| Do you have any allergies? |
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