|
|
|
|
|
Family name |
First
name |
|
|
|
| Date
of Birth |
Sex |
|
|
|
| Nationality
|
Occupation |
|
|
|
| Address
|
Passport
Number |
|
|
|
| Telephone
no |
Fax
no |
|
|
|
| E-mail
address -Required - Enter carefully |
Mobile
phone no |
|
|
|
| Emergency
contact details (name, address, phone/fax/email of
someone to contact in an emergency) |
|
|
| How
did you hear about Riviera English School? |
|
|
|
|
| Tuition |
| Course |
Level
of English |
|
|
|
| Total
Number of weeks |
Start
date
(normally a Monday)
|
End
date
(normally
a Friday)
|
|
|
|
|
| Other
course requirements |
|
|
|
|
Accommodation |
| Type
of Accommodation |
|
|
| Start
Date (Check-in) |
End
Date (Check out) |
|
|
|
|
|
|
|
|
| Other
accommodation requests or details of allergies/illnesses: |
|
|
|
|
Travel Details (if known) |
Arrival
Date
|
Arrival
Time |
Departure
Date
|
Departure
Time |
|
|
|
|
|
Airport/port/station
(Arrival) |
Flight
Number
(Arrival) |
Airport/station
(Departure)
|
Flight
Number
(Departure) |
|
|
|
|
|
| Would
you like us to book a transfer by National Express
coach? (cost will be about £60+ £5 booking
fee for a return ticket from/to Heathrow - depending
on booking date) |
Yes
|
|
No
|
|
| Would
you like us to book a taxi transfer (cost will be
about £200 one way from London Heathrow) |
Yes
|
|
No
|
|
| Other
notes about your arrival (for example- arrving by
car) |
|
|
Payment |
|
Minimum
booking deposit £200 (£200
will be deducted from the final invoice)
Payment
method
|
|
|
|
|
