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Book a Course

To make a booking please fill out the form below.

Personal details

Personal details

Title:

First name:

Family name:

Company name:

House name:

House number:

Street:

City/Town:

Prefecture:

Postcode:

Country:

Contact telephone:

Mobile number:

Email address:

Date of birth:

Native language:

Nationality:

What are your hobbies and interestes ?:

Do you have a physical disability that may affect your stay in any way ?:

Yes

Explain your disability:

Emergency contact

Emergency contact

Name:

Address:

Contact telephone:

Your Course

Your course

Number of lessons per week:

Course name:

Course dates

From:

To:

Activities

1 Activity is equal to 3 lessons

Activities

Number of lessons & activities:

Which activities would you like to do with your teacher?

First choice:

Second choice:

Third choice:

Fourth choice:

Fifth choice:

Sixth choice:

Location & Accommodation

Location & Accommodation

I would prefer a teacher in this location

First choice:

Second choice:

Third choice:

I will arrive into this airport/station:

Do you have any allergies ?:

Yes

Explain your allergy:

Your level of English

Your level of English

Do you study English at the moment ?:

Yes

How long have you studied English for ?:

Do you use English in your work ?:

Yes

Please estimate your level of English:

Speaking:

Listening:

Reading:

Writing:

Grammar:

What area of English do you want to develop ?:

Other information:

Arrival & Departure

Arrival & Departure

Would you like Homelingua to arrange a driver/taxi to meet you on arrival and/or departure ?: *

arrival only

departure only

not required

Your travel dates

From:

To:

I have read and understand the Terms and Conditions of bookings: *

Yes

Accredited by the British Council

Member of English UK

Call us today on +44 (0)1993 813 713 or email us at info@homelingua.com

© Homelingua 2008. All right reserved.
Homelingua, 5 Park Street, Woodstock, Oxfordshire OX20 1SJ, United Kingdom
Telephone: +44 (0)1993 813713 | Fax +44 (0)1993 813714 | info@homelingua.com

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