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LSI Registration Form

Please email, fax or post to:
LANGUAGE SPECIALISTS INTERNATIONAL, 1 - 13 Lord Montgomery Way, Portsmouth PO1 2AH
Telephone +44 23 92 291811
Fax +44 23 92 750435

Click here to download a PDF version of this form.

Required Fields*

 

1. Personal Details
Family Name*
First Names*
Male/Female*
Nationality*
Date of Birth*
Home Tel*
Mobile Tel
E-mail*
Fax
Address*
Occupation
How did you hear about LSI
 
2. Course Details
Course Basis - please tick the programme you require:
Option 1:
General English
Option 2:
Intensive General English
Option 3:
General English Examination
IELTS

Do you want to take the IELTS exam while you are at LSI?
Yes No
If Yes, which date?
Cambridge: students who wish to prepare for one of the Cambridge Examinations will need to take the Option 4 GENERAL ENGLISH PLUS ONE TO ONE COURSE and should tick the Option 4 box below. Which Cambridge Exam do you wish to prepare for?
(PET) -or- (FCE) -or- (CAE) -or- (CPE)
Option 4: General English plus One to One Course
Option 5: General English plus Business English Course


Option 6: Combination Course 50% General English Plus 50% One-To-One
Dates of Course
From*
To*
How many weeks*
3. Level Of English
 
Very Good
Good
Intermediate
Weak
Very Weak
Speaking
Listening
Reading
Writing

4. Host Family Accommodation
Would you like us to arrange host family accommodation for you? Yes No
Do you smoke ? Yes No
Do you have any special preferences concerning host family accommodation: e.g. size of family, age, children, household pets, hobbies/interests?
5. Arrival Details
Date and Time
Flight Number and Airport

Do you require a taxi transfer?
No One Way Return

BOOKING TERMS & BANK DETAILS:

a) Fees include General English course books, cassettes and teaching materials but do NOT include the optional evening social programme or weekend excursions.

b) All fees are fully payable in advance to:

LANGUAGE SPECIALISTS INTERNATIONAL
National Westminster Bank PLC
Commercial Road Branch
Portsmouth
England
A/c No. 89795482
Sort Code 56-00-64

c) After starting a course, if a student, due to exceptional circumstances, needs to terminate his/her course prematurely, it is LSI’s policy that all tuition and accommodation fees will be refunded subject to a four week period of notice and subject to a cancellation fee equivalent to two weeks’ tuition fees.

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