Booking

Please read the terms and conditions before completing this form.

Personal details
Family name
First name
Address
Country
Telephone number (home)
Telephone number (work)
Telephone number (mobile)
Fax.
Email
Nationality
Sex	female male
Date of birth (day/month/year)
Main language spoken
Course details
Course type
Starting date
Number of weeks

If you want to book a second course, please enter details here
Course type
Starting date
Number of weeks

Accommodation
If you would like us to book accommodation with a host famly for you, please complete this section, otherwise leave it blank:
The date you will arrive at the host family
The date you will leave the host family
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 (eg. allergies, vegetarian, special dietary needs, etc.), please give details here

Travel to / from Tunbridge Wells
	Arrival	Departure
Date (day.month.year)
Time
Flight number
Airport and terminal
Do you want us to book a taxi from/to the airport?	yes no	yes no

Payment
I wish to pay ...	by bank transfer to: Cicero Languages International HSBC Bank Plc 105 Mount Pleasant Tunbridge Wells TN1 1QP IBAN-No.: GB73MIDL40443781789643 BIC-CODE: MIDLGB216OJ Please add £20 sterling to cover bank charges
	by credit card (we will send you a payment form)

I have read and agree to the terms and conditions