Learn English at LTC International College in England


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About you ...

Family Name:	First Name(s):
Nationality:	Sex:	male female
First Language:	Date of Birth:
Occupation:	Age:
Address:		Country:
Phone:	Fax:
Mobile:	E-mail:
If you have a serious accident etc. in England, who should we contact in your country?
Name:	Relationship:
Phone:	(e.g. father, mother, husband or wife, ...)

Language skills

What level is your English?
Beginner \| Elementary \| Intermediate \| Upper Intermediate \| Advanced
Have you studied English abroad before? Yes \| No
If yes, where?	When?	How long for?
Which examinations have you passed?

Language courses

Which course would you like to take?
Start date:		End date:
Number of weeks:		Exam Prep:
How many hours? (One-to-One)		Examination:

Accommodation

Do you need homestay accommodation? Yes \| No, I will live at this address in England:
Single room
Shared with a friend/family etc.
I do not want to be with ...
Dogs	Young children	Phone:
Cats	Teenagers	Fax:
About your food - Do you eat ...		About your health - Do you suffer from ...
red meat? (eg beef)	Yes \| No	diabetes?	Yes \| No
white meat? (eg chicken)	Yes \| No	epilepsy?	Yes \| No
pork?	Yes \| No	an allergy?	Yes \| No
fish?	Yes \| No	Please say what:
dairy products? (eg milk, cheese, etc.)	Yes \| No	Are you taking medicine?	Yes \| No
special diet?		Please say what:

Arrival and departure

Date of arrival:		Date of departure:
Flight number:		Flight number:
Airport:		Airport:
Seaport:		Seaport:
Railway station:		Railway station:
Time of arrival:	(GMT)	Time of departure:	(GMT)

Transfer Service

Do you need a taxi from the airport to your accommodation? Yes \| No
on arrival	on departure

Payment

I like to pay by ...
bank transfer	a cheque in pounds sterling drawn on an English bank	credit card

Enrolment Form - Submission

I have read and understood the information concerning LTC's courses, dates and fees, including the information about cancellation and refunds and agree that my fees and the terms shall be as indicated. In case of accident or illness, I give permission to any appropriate medical centre to examine or treat me. I also give permission to release information regarding health to other designated individuals. I agree to inform LTC of any physical or psychological condition and any medication I am taking. If you let the agency of InterEastCom help you to book, there are no extra charges.