Personal Details
Family name*:
Please enter your family / last name.
First name*:
Please enter your first name.
Title (Mr, Mrs, Ms, Miss etc.)*:
Please enter your title.
Address*:
Please enter your address.
Country*:
Please enter your country.
Telephone numbers*:
Please enter your contact telephone number. (home)
(work)
(mobile)
Fax number:
Email address*:
Please enter your email address. Please enter a valid email address.
Nationality*:
Please enter your nationality.
Sex*:
Please select
male
female
Please select your sex. Please choose your sex.
Date of birth*:
Please enter your date of birth. Please enter in form dd/mm/yyyy.
Main language spoken*:
Please enter your main language.
Current level of English*:
Please select
Beginner
Elementary
Pre Intermediate
Intermediate
Upper Intermediate
Advanced
Please choose your current level of English. Please select your level..
Course details
Course type*:
Please select
GA.10: General English afternoons only
GC.20: General English 20 lessons
GC.30: General English 30 lessons
CI.25: Combination Intensive 25 lessons
CI.30: Combination Intensive 30 lessons
CI.35: Combination Intensive 35 lessons
GB.35: General + Business English 35 lessons
IE.30: IELTS
FT.20: Fast Track course 20 lessons
FT.30: Fast Track course 30 lessons
FT.40: Fast Track course 40 lessons
FE.20: Family English course 20 lessons
X1: Afternoon Tea
X2: Aromatherapy
X3: Art
X4: Cake decorating
X5: Cookery
X6: Dancing
X7: Flower arranging
X8: Gardens
X9: Golf
X10: Horse-riding
X11: Interior design
X12: Tennis
Please select a course. Please choose a course.
Starting date*:
Please select
25.01.2010
01.02.2010
08.02.2010
15.02.2010
22.02.2010
01.03.2010
08.03.2010
15.03.2010
22.03.2010
29.03.2010
05.04.2010
12.04.2010
19.04.2010
26.04.2010
03.05.2010
10.05.2010
17.05.2010
24.05.2010
31.05.2010
07.06.2010
14.06.2010
21.06.2010
28.06.2010
05.07.2010
12.07.2010
19.07.2010
26.07.2010
02.08.2010
09.08.2010
16.08.2010
23.08.2010
30.08.2010
06.09.2010
13.09.2010
20.09.2010
27.09.2010
04.10.2010
11.10.2010
18.10.2010
25.10.2010
01.11.2010
08.11.2010
15.11.2010
22.11.2010
29.10.2010
06.12.2010
13.12.2010
Please select a start date. Please choose a start date.
Number of weeks*:
Please enter the number of weeks. Please enter numbers only.
If you want to book a second course, please enter details here:
Course type:
Please select
GC.20: General English 20 lessons
GC.30: General English 30 lessons
CI.25: Combination Intensive 25 lessons
CI.30: Combination Intensive 30 lessons
CI.35: Combination Intensive 35 lessons
GB.35: General + Business English 35 lessons
IE.30: IELTS
FT.20: Fast Track course 20 lessons
FT.30: Fast Track course 30 lessons
FT.40: Fast Track course 40 lessons
FE.20: Family English course 20 lessons
X1: Afternoon Tea
X2: Aromatherapy
X3: Art
X4: Cake decorating
X5: Cookery
X6: Dancing
X7: Flower arranging
X8: Gardens
X9: Golf
X10: Horse-riding
X11: Interior design
X12: Tennis
Starting date:
Please select
25.01.2010
01.02.2010
08.02.2010
15.02.2010
22.02.2010
01.03.2010
08.03.2010
15.03.2010
22.03.2010
29.03.2010
05.04.2010
12.04.2010
19.04.2010
26.04.2010
03.05.2010
10.05.2010
17.05.2010
24.05.2010
31.05.2010
07.06.2010
14.06.2010
21.06.2010
28.06.2010
05.07.2010
12.07.2010
19.07.2010
26.07.2010
02.08.2010
09.08.2010
16.08.2010
23.08.2010
30.08.2010
06.09.2010
13.09.2010
20.09.2010
27.09.2010
04.10.2010
11.10.2010
18.10.2010
25.10.2010
01.11.2010
08.11.2010
15.11.2010
22.11.2010
29.10.2010
06.12.2010
13.12.2010
Number of weeks:
Accommodation
Please book accommodation for me*:
Please select
Yes
No
Do you want us to book accommodation for you? Do you want us to book accommodation for you?
The date you will arrive at the host family:
Please enter date in form dd/mm/yyyy.
The date you will leave the host family:
Please enter date in form dd/mm/yyyy.
Do you smoke?
Yes
No
Are you happy to be in a smoking family?
Yes
No
If you have, or have recently had, any medical condition (physical or mental) which might affect your studies, or which your host family should know about, please give details:
If you have any special wishes regarding your accommodation (e.g. allergies, vegetarian, special dietary needs, etc.), please give details:
Travel to / from Tunbridge Wells (optional)
Payment
I wish to pay*:
by credit card we will send you a payment form by email
by bank transfer to:
Cicero Languages International HSBC Bank PLC
105 Mount Pleasant Tunbridge Wells TN1 1QP
IBAN-No.: GB73MIDL40443781789643
BIC-CODE: MIDLGB2160J
Please add £20 sterling to cover bank charges
How do you want to pay?
Terms and conditions*:
I have read and agree to the terms and conditionsYou must accept the terms and conditions.
Please fill out all fields marked with a *.