EJO Elizabeth Johnson Organisation

Completing our Enrolment Form Requires 4 Steps:

1. Choose your course and dates in order of preference.
2. Fill in your information as completely as possible in order to tailor your experience to your personal needs.
3. Choose your Payment method. Submit the form.
4. Please the fill out the Medical Information and submit the form.

means this is a required field

 

• Course:
• Please select a Course Fast Track IELTS General English Business English Professional English Special Interest Course 1 to 1 Training Company Personnel Young Learners (under 16)

• Arrival:
• Select date

• Departure:
• Select date

Arrival date is normally a Sunday to start lessons on Monday. Leaving date is normally a Saturday.

Type of Course: One To One  Two To One Select Lessons Per Week 15 20 25 30

Area Preferred: London  Outside London

We will try to comply with your preference for location, however the choice of family most suitable for your requirements will take priority.

Contact Information:

Title: Mr. Mrs. Ms. Dr.

Firstname:

Lastname:

Email Address:

Confirm Email:

Phone:

Fax:

Address:

Town:

Province, County:

Country:

Postal Code:

Passport Information:

Passport Number:

Passport Country:

Mother Tongue:

Religion:

Sex: Male  Female

Age:

Date of Birth: 12345678910111213141516171819202122232425262728293031 123456789101112 19241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009

Alternative Contact Information:

Company Name:
(if applicable)

Position in Company:

Company Address:

Work Phone No:

Work Fax No:

Next of Kin:

Next of Kin Phone:

Level of English:

English Experience:

Standard of English: Beginner  Elementary  Intermediate  Advanced

Special Conditions:

Special Interests:

Special Diet Needs:

Do you have any allergies or special medical requirements? Yes  No  
If yes give details:

Do You smoke? Yes  No

Special Remarks: Enter Instructions, Comments or Concerns

Arrival Time:

Depature Time:

Station/Airport:

Station/Airport:

Flight/Train No:

Flight/Train No:

Method Of Payment:

A non-refundable deposit of £100 is required to process your enrolment. Please select one of the following 3 options:

Credit Card (2.62% service charge payable)

All sensitive Credit Information is handled through SECURE Server Transactions

Please select your card type: VISA MasterCard

Credit Card Number:

Security Code:
(last 3 digits on the back of your card)

Expiry Date:
(yyyy/mm)

Bank Transfer (Please add £10 to cover UK Bank charges )

All sensitive Credit Information is handled through SECURE Server Transactions

Bank Transfer Details:

 

All fees should be paid to:

Elizabeth Johnson Organisation LLP
Account No: 8383 5561 - Bank sort code 20-90-56
Barclays Bank plc, Weybridge Branch, Walton on Thames Group
PO Box 193, 8/12 Church Street
Walton on Thames, Surrey KT12 2YW
England

IBAN Code: GB83 BARC 2090 5683 835561
International Swift BIC Code: BARCGB22 209056 8383 5561

Mail

Please send payment (International Money Order or UK Bank cheque) to:

Elizabeth Johnson Organisation LLP
Eagle House, Lynchborough Road
Passfield, Hampshire GU30 7SB
England.

Terms and conditions:

Please read and/or download the Terms and Conditions (Word Doc)

I agree to the conditions of enrolment as set out in the Terms and Conditions