| 1. Name: |
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Age: |
| 2. Address |
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| 3. City |
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Postal Code/Zip Code |
| 4. Telephone |
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Fax: |
Email: |
| 5. Classes/Accommodation/Meals |
2 wks @ $2380 shared room___ |
1 week @ $1300 Can shared room___ |
(ONLY first week of session) |
and Activities (all Inclusive) |
2 weels @ 3080 private room ___ |
1 week @ $1640 Can private room ___ |
(ONLY first week of session) |
| 6. Class Dates Preferred: |
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Two Weeks Program |
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One Week Program |
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July 23 –August 5 ___ |
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July 23 – 29 ___ |
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August 6 – August 19 ___ |
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August 6 – 12 ___ |
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August 20 – September 2 ___ |
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August 20 – 26 ___ |
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September 3 – September 16 ___ |
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September 3 – 9 ___ |
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September 17 –September 30 ___ |
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September 17 – 23 ___ |
| 7. Class Level (X) |
1 __ |
2 __ |
3 __ |
4__ |
5__ |
| |
Beginner |
Intermediate |
Advanced |
| 8. Previous English studies taken: |
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| None |
Formal |
Informal/Self Study |
Immersion (# ______ weeks) |
| Are you comfortable using: |
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| verbs |
questions |
past tenses |
object pronouns |
| When did you last study English ? |
For how long? |
| 9 . Medical Condition: Any physical condition for which you are receiving medical treatment or medication? |
| |
Yes___ |
No___ |
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Please indicate details of medical condition and medications required:
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| 10 . Any allergies? |
Yes___ |
No___ |
Specify |
| 11. Contact Name and Address of Nearest Relative or Friend : |
| Name: |
Relationship: |
Tel.: ( ) |
Email: |
| Address: |
City: |
Postal Code: |
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12. Flight Arrangements : (if known)
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| Payment Options : |
1. Deposit $200 Can with registration, and full payment required 2 months prior to arrival
2. Mail cheque or money order made out to : Jean Hnytka and send to VanCity Savings, Br. 10, 898 W. Pender St., Vancouver, BC, V6C 1J8
3. Wire Transfers - Please email for instructions Wildenglish @talkadventures.com
4. Paypal Register with www.paypal.com
a) For Non Credit card and Non Debit payment by Paypal by Emailing to yesi@talkadventures.com
b) Credit Card Payment ONLY for deposit via www.Paypal.com by send money to yelapa2002@hotmail.com .
5. Please email your registration to Wildenglish @talkadventures.com and indicate payment dates and options. |
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