TYPE OF BOOKING
Private / Company / Agent / Agent Name:
PERSONAL DETAILS
Private details / Work details
Mr / Ms: / Mr Ms / Employer name:
Family Name: / Work Address:
First Name(s):
Home Address: / Tel:
Fax:
Tel: / Work email:
Private email: / Job/position:
Nationality: / Training/HR Manager:
Mother Tongue: / London Details
Date of Birth: / Day:Month:Year: / London Address (if any):
Level of English / (See Dates & Fees page 11)
How did you hear about us? / London Tel:
COURSE SELECTION
Course / Start date / Finish date / Weeks
1
2
3
4
5
ADDITIONAL SERVICES

Please tick all the additional services you require.

Airport transfer: please fill in the details below

Accommodation: please fill in the details on the back of this form

Restaurant pass (Holland Park Gardens only): I would like a restaurant pass for weeks

Pre-course Distance Learning

AIRPORT TRANSFERS

Arrival pick up £75 Departure (drop off only) £55

Date / Time / Airport / Terminal / Flight number / From
Arrival
Departure
ACCOMMODATION
1. Please indicate your preferred and second choice of accommodation by placing 1 or 2 in the spaces below.
Silver homestay / Gold homestay
Bed and breakfast only: £120 / Bed and breakfast only: £195
Bed, breakfast and dinner three nights/week: £145 / Bed, breakfast and dinner three nights/week: £245
Bed, breakfast and occasional meals: £120 + £9 per meal / Bed, breakfast and occasional meals: £195 + £12 per meal
Bed, breakfast and dinner every night: £175 / Platinum homestay: from £450/weeksubject to availability
Hotel  / Hotel  / Hotel  / Apartment / Apart-hotel
Student Residence / Executive Residence
2. Please answer the following questions / Yes / No / Not important / Yes
Would you like a host family with children? / Do you smoke?
Would you like a lot of contact with your host? / (Very few of our families allow smoking in the house,but most will
allow guests to smoke outside)
Would you like internet access? (There is an extra charge of £8/week for this and availability is limited. See note 1 on page 5)
I am prepared to smoke outside

I:\Market\Publicity materials\Registration forms 2007\LSE Registration Form 2007.rtf

Please give details of any allergies, strong dislikes (eg to animals) or special requests (eg if you are a vegetarian).

PAYMENT
1. Calculation / 2. Payment type
Course fee(s) / Please say which type of payment you want to make at this point
Registration fee / £35 / I want to pay the full fees now.
Accommodation / I would like to pay the deposit of £500 and £35 registration fee now (plus £30 fee if the schoolis arrangingaccommodation and £150 deposit if I require homestay). The full fees will be paid at least 30 days before the course starts.
Accommodation placement fee £30
Airport Transfer
Restaurant pass £50 p/w
TOTAL COST
3a. Payment by Bank Transfer
I am paying by Bank Transfer and I will provide a copy of the bank advice. Please be sure to pay all bank charges at your end.
London School of English bank is: Barclays Bank, Pall Mall, London.
Sterling Account 10468606. Sort code 20-06-05. IBAN GB15BARC20060510468606 Swift code BARCGB22.
Euro Account 45454733. Sort code 20-06-05. IBAN GB65BARC20060545454733.
3b. Payment by Cheque
I enclose a Cheque drawn on a UK bank (British banks do not accept Eurocheques).
3c. Payment by Credit Card
I am paying by Credit Card. / Card type: VISA MASTERCARD AMEX DELTA SWITCH SOLO
Card number:
Valid from: / Valid to:
Security code: / (the last three numbers printed on or below the signature strip on the back of the card)
I authorise the London School of English to charge my credit card with the amount(s) indicated above where appropriate.
Note: We will charge your card in your own currency. If you prefer us to charge you in pounds sterling, please tick here:
Name on card (if not your own): / Signature of cardholder:
3d. Payment via Invoice
Please invoice my company / Company name:
Please invoice me / Company address:
Optional information: / Tax number: / VAT number: / Purchase number:
CONFIRMATION

Please reserve me a place on the course(s) indicated. I have read and accepted the school’s terms and conditions of registration.

Signature:Date:

I:\Market\Publicity materials\Registration forms 2007\LSE Registration Form 2007.rtf