Apply for a Languages Plus course

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del Carmen
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Apply for a Languages Plus course

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Application form for Languages Plus courses
About you
Family name *
Other name(s) *
Date of birth *
Sex *	Female Male
Citizenship *
Own language *
Home address *
Postcode/zip
Country *
Telephone
Fax
Email *
Visa status *	I have a valid visa I will apply for a visa I do not need visa I am not sure if I need a visa
What is your present language level?
How did you first hear about Languages Plus?
Your course
Course *
Type of course *
Start Date *
Course length
Your accommodation
Do you want Language Plus to organise your accommodation for you? * Yes No
Accommodation
Single room required? (where available)	Yes No
Do you smoke? *	Yes No
Details of any allergies or medical conditions you have:

Details of any special requirements or other information the host family or residence should know about, for example diet information:

Declaration - all applicants must complete this section
I have read the booking conditions and accept them. * Yes
I have read and understood the relevant schedule of costs set out in the current Languages Plus price lists and hereby affirm that I have sufficient funds to pay for all tuition costs as well as the cost of all food, accommodation and all other personal expenses during the full period of my course at Languages Plus. * Yes
I certify that all information given by me in this enrolment form is accurate and correct. * Yes
Before submitting this form, we suggest that you print it out for your records.