| General details |
|
Mr/Ms/Mrs/Miss/Other |
|
First Name* |
|
Family Name* |
|
Nationality* |
| Contact details |
|
Address Line 1 |
|
Address Line 2 |
|
Town/City |
|
Postcode |
|
Country |
|
Telephone* |
|
Email* |
|
Mobile |
|
Fax |
| Contact in case of emergency |
|
|
Name |
|
Telephone with code |
| Personal details |
|
Date of birth* |
Male
Female
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Sex |
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Occupation |
|
Mother Tongue |
|
Second Language (if bilingual) |
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Yes
No |
Smoker |
|
Special Diet/Allergies |
|
Do you have any medical condition we
should know about |
|
How did you hear about Regent? |
|
Yes
No |
Have you attended a Regent course before? |
| Level of English |
What is your English
level?
Beginner
Elementary
Pre-intermediate
Intermediate
Upper-intermediate
Advanced |
| Please select your location |
Regent schools:
Bournemouth
Brighton
Cambridge
Edinburgh
London
Oxford
Sydney
Home Tuition
|
| Please select your course |
English World Courses:
English World Intensive
English World Semi-Intensive
English World Combination
Semester Programmes:
IELTS Exam Preparation
Cambridge Exam Preparation FCE
Cambridge Exam Preparation CAE
Cambridge Exam Preparation CPE
UFP
ASP Intensive (24wks)
AYP Intensive (32wks)
ASP Semi-Intensive (24wks)
AYP Semi-Intensive (32wks)
Elite World Courses:
ClasSIX FT
ClasSIX Combination
ClasSIX AM
Executive Courses:
Executive Group
Executive Group Plus
Executive Combination 1
Executive Combination 2
Executive Combination 3
Individual Tuition:
Individual 30
Individual 25
Individual 20
Individual 15
Home Tuition:
Home Tuition 25 Location:
Home Tuition 20 Location:
Home Tuition 15 Location:
Work Experience Placement:
English World
ASP
AYP
Refresher Courses for Teachers of English (only in London and Oxford):-
|
| Additional one-to-one hours per week |
5 hours per week
7.5 hours per week |
| Course start/end dates |
|
Start Date (DD/MM/YY) |
|
End Date (DD/MM/YY) |
Adult accommodation
|
Please choose your
type of accommodation?
Homestay
Homestay Ensuite
Hotel/Guesthouse
Residence
|
| Dates |
|
|
Accommodation Start Date (DD/MM/YY) |
|
Accommodation End Date (DD/MM/YY) |
| Transfers |
|
Would you like a transfer to your accommodation?
Yes on arrival
Yes on departure
No
|
| Medical and Travel Insurance |
You must have Medical and Travel Insurance if you book a course with us so please provide us with proof that you have adequate cover.
I have adequate cover
|
| Payment |
Cheque (UK £ Sterling only) made payable to the school you wish to attend. Please write the students name on the back of the cheque
Bank Transfer - Please click here for bank details (opens in a new window)
Credit Card - Contact us by telephone to give us credit card details. Alternatively, download the Registration Form above, complete all details including your credit card information and post to us |
| Terms and conditions |
I do not wish to be contacted by mail in the future
I do not wish to be contacted by email in the future
I have read and accept the terms & conditions. |
| Complete this form and contact
us by telephone to confirm credit card details. Alternatively,
download the Registration Form above, complete all details including
your credit card information and post to us. |
|
|
