Personal Details

Family Name

First Name

Gender

Male
Female

Nationality

Passport Number

Expiry Date

Date of Birth

Day

Month

Year

Home Tel

Mobile Tel

E-mail Address

Employment Details

Company Name

Full Work Address

Telephone

E-mail Address

What type of work is your company involved in?

Job Title

Department

Please write a brief description of your job

Course Options

Option A: One to One
Option B: Closed Group
Option C: Open Group
Option D: Combination

Dates of Course

Date From

Date To

How many weeks?

Accommodation

Accommodation is usually available from Sunday; i.e. the day before the course commences

Type required - please tick as appropriate

Executive Host Family
Hotel

Lunch with tutor

Do you smoke?

Yes
No

Do you have any health problems or dietry needs

Do you have any special preferences concerning host family accommodation: e.g. size of family, age, children, household pets, hobbies/interests?

Arrival Details

Arrival Date

Arrival Time

Arrival Airport

Flight Number

Do you require a taxi transfer?

No
One Way
Return

Level of English

Course Objective

Please summarise briefly what you would like to achieve during your course at LSI, indicating which language skills you would most like to improve

Please number to 4 most important in order of priority

Speaking and Understanding

Meetings

Negotiating

Presentations

Selling

Telephoning

Socialising/Entertaining

Travelling

Cultural Awareness

Reading and Writing

Emails, faxes and letters

Reports

Instruction Manuals

Contracts/Agreements

How did you hear about LSI?

Other