GEOS English Academy Brighton and Hove

Section 1: Your Course
Course Name
Lessons per week
Number of Weeks you want to study
Course Starting Date (Day/Month/Year)
Section 2: Personal Details
Family Name
Given Names
Date of Birth
Gender	Male Female
Nationality
Home Address
Telephone
Email
Verify Email address
What is your language Level?

Section 3: Accommodation

Would you like us to arrange accommodation for you	Yes No


If No, where will you live (please give as much details as possible)
What type of Homestay accommodation will you need?

Do you Smoke?	Yes No
Is it OK if the family Smokes?	Yes No
Any other requests (e.g. not dogs, no cats, I like Children)
Are there any foods you cannot eat? Please say "Yes if you do and "No" if you do not eat the following.
Red Meat	Yes No
White Meat	Yes No
Pork	Yes No
Fish	Yes No
Dairy	Yes No
Other
Do you have any health problems (e.g. allergies, diabetes, epilepsy)	Yes No
Please give details
Are you on any medications?	Yes No
If yes, please give details
Do you want us to arrange a taxi transfer from the airport. If yes, tell us which airport?

Section 4: Educational Agents
Please complete if you are an educational agent making a booking on behalf of a student
Agency Name
Contact Person
Email
Telephone
Fax
Telephone
Section 5: Terms & Conditions
By submitting this form to the school you agree to abide by the school’s terms and conditions of enrolment, including the cancellation and refund policy. These can be found on our Dates and Fees information. We will ask you for additional personal information before you arrive at the school and on your first day. After you submit this form, the school will ask for a deposit of £GBP 200 or 10% of tuition fees for programmes of 32 weeks or more before proceeding with reserving your place or releasing registration letters which can be used for visa applications. An invoice will then be sent to you for the remaining balance of tuition, accommodation charges and any other fees. Full payment is expected 2 weeks before the start of the course. Fees are non transferable and non-refundable. We are not able to accept beginners. Our website does not accept payments. You can pay by sending us you credit card information, pay by bank transfer (you can find our bank details on our Fees and Dates information sheets) or via our PayPal account - info@geos-brighton.com I have read and accepted the terms and conditions of booking and enrolment.

Write to us:

GEOS English Academy Brighton & Hove
55-61 Portland Road
Brighton & Hove
East Sussex
BN3 5DQ
England

Call us:
Tel: +44 (0) 1273 735975 / 721612
Fax: +44 (0) 1273 732884