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:
Phone:		Fax:
Mobile:		E-mail:
If you have a serious accident etc. in England, who should we contact in your country?
Name:		Relationship (eg father):
Phone:
Have you studied English abroad before?			Yes \| No
Where? When? How long for?
What level is your English?
Elementary \| Intermediate \| Advanced
Which examinations have you passed?
Why would you like to study English?
For an examination	For my work	To prepare for further study	Other Why?
Which course would you like to take?
General English 20 lessons a week 25 lessons a week		Young Learners Holiday Course 15 lessons a week plus activities Residential accommodation in LTC
General English Plus 20 General English lessons a week? 25 General English lessons a week? How many hours One-to-One per week?		One-to-One How many hours a week? Computer Training Please tell us your requests:
Examination Course 25 lessons a week Which examination? FCE (Cambridge First Certificate) CAE (Cambridge Advanced English)
Academic Year Programme 7th January -28th March 2002 8th April - 14th June 2002		Pre-MBA Course 7th January - 15th March 2002 8th April - 14th June 2002
When would you like to study?
Start date:	End date :	Number of weeks:
Do you need homestay accommodation?
Yes Single room Shared with a friend/family etc.		No, I will live at this address in England:
I do not want to be with:
Dogs	Young children	Phone:
Cats	Teenagers	Fax:
Any other preferences?
Do you need a taxi from the airport to your accommodation?
Yes Arrival only Arrival and departure from London Gatwick (LGW) from London Heathrow (LHR) from London Stansted (STN) from Please tell us your flight details as soon as possible:		No Please tell us what time you think you will arrive at your accommodation.
Do you smoke?
Yes \| No	Is it OK to be with a family who smoke? Yes \| No
About your food ...		About your health ...
I do not eat red meat (eg beef)		Do you suffer from ...:
I do not eat white meat (eg chicken)		diabetes?
I do not eat pork		epilepsy?
I do not eat fish		an allergy? Please say what:
I do not eat dairy products (milk, cheese, etc.)
Other: Please say what:		any other condition? Please say what:
		Are you taking medicine? Yes No If yes, what:
Who told you about LTC?
A friend/relative	An agent	the British Council	Other
Your £200 deposit ...
has been sent by bank transfer to LTC		has been posted to LTC	is enclosed
Please read this carefully before you submit. 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.