Application for Enrolment onto Postal Courses

Course

For which course are you applying?	- - Please select one - - Preliminary Certificate [Level 1] Certificate in Educational Studies [Level 2] Cert.(TM)TESOL (Higher Certificate) [Level 3] Certificate in Practical Phonetics
In which month would you like to start the course?	Straight away January February March April May June July August September October November December

Personal details

Title	Mr Mrs Ms Miss Dr
First name(s)
Family name
Telephone
E-mail
Address, line 1
Address, line 2
Town/City
County/State
Country
Post/Zip code
Mother tongue
Nationality
Date of birth
Occupation

Academic and Professional Qualifications

1. Qualification
Institution
Date awarded
2. Qualification
Institution
Date awarded

Payment

How would you like to pay?

Debit or credit card    Cheque Bank Transfer

Do you wish to pay in full, taking advantage of the 10% discount, or pay by interest free instalments? In full    By instalments If paying by instalments the initial payment is due with this application. You will then receive an invoice with amounts and dates due in your first postal pack.

Declaration

In submitting this form I confirm that to the best of my knowledge the information given on this form is true and correct. I have read and understood the conditions set out under Conditions and Refunds and agree to abide by them. (please tick)
Date

Check and send