On-line Enrolment Form
Name of language agency (if applicable)
Your first name:
Your surname:
Your nationality:
Your address:
Postcode:
Country:
Your date of birth:
:
day
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month
January
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year
1990
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1931
1930
E-mail address:
Do you suffer from any illnesses or disabilities:
please choose:
yes
no
If yes, please give full details:
Arrival date
(must be a Sunday in July or August)
:
day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
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31
month
January
February
March
April
May
June
July
August
September
October
November
December
year
2009
2010
Departure date
(must be a Saturday in July or August)
:
day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
month
January
February
March
April
May
June
July
August
September
October
November
December
year
2009
2010
Residence preferred:
please choose:
Schafer House
Dinwiddy House
Please estimate your level of English:
please choose:
elementary
intermediate
advanced
Please note:
this booking will not be confirmed until you have made payment and received confirmation.
© City English World 2008 - 2009