ELC - English Language Centre, York

Registration Form

Apply Online - Registration Form
Before completing this form, please read the section on 'How to Apply' Please complete this form accurately. Fields marked * cannot be left blank.

Your Course: Course prices are as indicated in Tuition Fees 2007/8

Course Required		*
Course Start Date		*
Number of Weeks		*

Your Personal Details:

Title		*
If other, please specify here
Gender:		Male Female *
First Names		*
Family Name		*
Date of Birth		*
Age		*
Home Address in your country		*
Telephone Number (Including area code)		*
Fax Number
Email Address		*
Nationality (Passport issued by)		*
Passport Number		*
First Language		*
Current English Level		*
Occupation		*
Details of any Sponsor for your course
Name of the person who will be paying your Registration Fee(if not you)

Accommodation:

Accommodation Start Date		*

Accommodation End Date		*

Will you require Homestay Accommodation		Yes No *

If yes, would you like:		Standard Executive Not required * ('Information about homestay')
ttab	A host family with dogs?	Yes No *
tab	A host family with Cats?	Yes No *
tab	A host family with small children?	Yes No *
tab	A smoking Host Family?	Yes No *
tab	Do you smoke?	Yes No *

tab	Do you have any special accommodation requirements?

tab	Do you suffer from any allergy or medical condition?	Yes No *

tab	If "Yes" please give details
If you do not require Homestay Accommodation:
tab	Would you like information about Guest House or Hotel accommodation?	Yes No *

tab	Will you arrange your own accommodation?	Yes No *

An enrollment fee of 100 GBP (non-returnable) must be paid to confirm your registration. This includes a 40 GBP registration fee and 60 GBP course fee deposit. If you pay in 2007, all 2008 fees will be at 2007 prices. Details of how to pay this fee will be given after you submit your form. Please read our terms and conditions of booking before proceeding to the payment stage I have read and agree to all terms and conditions * Please check that the information you have entered on this page is correct before clicking 'Submit Form' and proceeding to the payment stage.