Book a course

Please read the terms and conditions before completing this booking form.

Please complete all of the fields marked with a *. When you click "send booking" the page will check that you have filled everything out. If you haven't, the booking will not send. Please re-check the page and then you can send the booking again.

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 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 choose your current level of English.Please select your level..

Emergency contact person's name*:

Please give us the name of your emergency contact.

Emergency contact person's telephone number*:

Please give us your emergency contact's phone number.

Emergency contact person's relationship*:

What is your relationship with your next of kin?Please select an item.

Where did you hear about us?

Where did you hear about us?Where did you hear about us?

Course details

Course type*:

Please select a course.Please choose a course.

Starting date*:

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:

Starting date:

Number of weeks:

Accommodation

Please book accommodation for me*:

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)

	Arrival	Departure
Date:	Date form dd/mm/yyyy.	Date form dd/mm/yyyy.
Time:	Time form: hh:mm.	Time form: hh:mm.
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 credit card
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 *.

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