English

EF Enrolment Form

Please complete this form and return with your Enrolment Fee and optional Cancellation Insurance Premium.

Course Starting Date (Day/month/year) _____________________ Number of weeks _______________

Your Personal Details ----------- Male --------- Female

First Name(s) _______________________________ Last Name __________________________________

Date of Birth (Day/Month/Year) ____________________ Nationality _____________________________

Address _______________________________________________________________________________

City & Post Code ________________________________ Country _______________________________

Tel No. (Home) __________________Tel No. (Work) ______________ Fax No. ____________________

Your profession _________________________ Name of school or Employer _____________________

Please indicate your choice of Course and School

Course Type	London	Bournemouth	Cambridge	Brighton	Hastings	Cambridge University
Intensive						Jul/Aug only
Principle						not available
Summer						not available
Cambridge Exam						not available
TOFEL/Other						not available
Academic Year						not available

Accommodation	London	Bournemouth	Cambridge	Brighton	Hastings	Cambridge University
Host family- twin						not available
Host family-single						not available
Residence-shared						Jul/Aug only
Residence-single						Jul/Aug only

Please tick the following if applies or leave blank.

Your Signature confirming that you have read and agree to the conditions outlined and you authorise EF to take appropriate action in the unlikely event of a medical emergency.

Signature of applicant:____________________________ Date:__________________________________

Signature of parent or Guardian (if applicant is under 21) ___________________ Date: ____________

Please Print this Form and mail or Fax it to Cydamos Ltd. Fax 0044 207 72720155 or

E Mail to cydamos@i12.com