Family Name  
First Name     

Address       
City              
Country        
Post/Zip code
Telephone    
Fax              
email           

Sex:             male              female
Date of birth (dd/mm/yyyy) 
Occupation

Course Information

General English 15 hours per week
I wish to upgrade to 21 hours per week for an extra GBP30 per week:    yes           no
Start date (dd/mm/yyyy)      Finish date (dd/mm/yyyy)

Are you a beginner in English?    Yes      No


Accommodation

If you would like the School to arrange accommodation for you, please complete this part of the form.

Arrival date (Sunday - dd/mm/yyyy):

Departure date (Saturday - dd/mm/yyyy):

Do you have any medical condition that you wish us to know?



Homestay

Help us to choose the right family for you by answering the following questions: We will try to meet your requirements.

Do you smoke? Yes No

If you don´t smoke, would you accept a family where people smoke? Yes No

Would you accept a family with young children? Yes No

Would you accept a family with a pet (dog, cat, bird, etc.) Yes No


Dover House (Residence)

Single room Shared room

How to apply for a course

Send this application form together with a Deposit (200 GBP) to confirm your enrolment and to book your accommodation.
Your accommodation will be reserved from the Sunday before your course begins until the Saturday after it ends.

We will send you a Certificate of Enrolment and a statement of the fees that you will have to send to the Subdireccion General de Becas y Promocion Educativa.

Please choose a method of payment. Cheque, bank transfer or credit card.

Please make sure that your name appears on the transfer document. Please pay all bank charges. If charges are deducted in Britain, we will ask you to pay them when you arrive.

Please note that this is not a secure site. You may prefer to give us your card details on the phone, via fax or email.

Credit card Visa Mastercard JCB

There will be a 3% surcharge for credit card payments.

Name of card holder:

Expiry date:

Card number:

Debit from my account 200 GBP Deposit.

Debit from my account the balance of tuition and accommodation fees 7 days before the start of my course (We will confirm the amount when we receive this form).

Person or organisation paying the fees:

Myself Parent Other:

I accept the Terms and Conditions. I agree to pay the rest of the fees not later than 7 days before the start of my course (For students under 18 years old, a parent or legal guardian should sign).

Please tick this box if you do not wish your photographs, taken in connection with your course, to be used for promotional purposes (i.e. website, presentations, etc.)