Last Name

First Name

male female

Address

City

Postal Code

Country

UK Address

International Address

Phone

Mobile Phone

E-mail

Country of Birth

Date of Birth

Age

Nationality

Mother tongue

Company

Company Contact

Emergency Contact Person

Emergency Contact Person Address

Emergency Contact Person Telephone

Emergency Contact Person email

Please tick a box for the desired course:

English Course Fast Track Executive CIP + lunch CIP full day CIP half day Combo Course Duo Group Full Day Group Half Day

Previous english qualifications

Our English courses start every week and run from Monday to Friday. Our group size is 5-8 persons for both English and foreign languages. Private and Duo lessons are also available all year round. (Bank holiday Monday lessons will be rescheduled in the remaining days of that week)

Foreign Language course noneArabicBulgarianCroatianDutchEnglishFrenchGermanGreekHungarianItalianJapaneseKiswahiliMandarinNorwegianPolishPortugueseRussianSlovenianSpanishSwedishTurkish

Type of lessons: Private lessons Duo lessons Group lessons

Desired start date:

Number of weeks you wish to study:

Present inlingua level: 1A1B2A2B3A3B4A4B5A5B

Flight Details Airline, flight number and time of arrival

Arrival Date

Do you require any accommodation? Home Stay Bed and Breakfast Hotel Self-catering flat

Host Family – Accommodation is on half-board basis (breakfast and dinner) in a single bedroom. In order to find the most suitable host family for you please provide us with the following information:

Category A (private bathroom) Category B (shared bathroom)

Departure Date

Total number of nights required

Do you smoke? yes no

Are you allergic to pets? yes no

If yes, please describe:

Would you prefer a household with children?

yes no does not matter

Will any of your family members join you? (If so, there will be an additional fee payable for the extra accommodation and meals provided)

yes no

If yes, please specify:

Other (interests, hobbies, special dietary requirements,...) specify below:

I agree to be responsible for all ISA programme fees, as well as any incidental costs incurred by me, including, but not limited to, host family fee, telephone calls, airport pick-up and any damages caused by my actions.

How did you hear about inlingua? from inlingua.com Filmhouse folder recommendation websearch signboard other

If other, please specify: