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Printable Application for Enrolment, Course Registration & Assessment for Postal Courses

For which course are you applying? please circle or highlight one of the following

Preliminary Certificate     Certificate of Ed. Studies      Certificate in Phonetics     Certificate in Theory & Methodology of TESOL
Advanced Certificate in TESOL
I would like to start in: ____________ month
Title __________
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 ____________________________________
Highest qualification ____________________________________
Awarding body & date ________________________________________________
Payment method



  tickbox image Paypal (credit/debit card)     tickbox image Bank transfer     tickbox image Cheque

If paying by credit/debit card we will e-mail you a Paypal request for the amount due.

Do you wish to pay in full, taking advantage of the 10% discount, or pay by interest free instalments?
In full    By instalments    please circle or highlight one    (Payment in full or initial payment is due when enrolling.)
If paying by instalments you will receive an invoice with amounts and dates due for subsequent payments in your first postal pack.


Any special offers currently available will be automatically deducted from the payment in full fee listed. Please contact us with any queries you may have.
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.
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Signature

Date

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