Tel: 01424 813696 | Email: marketing@buckswoodstgeorges.co.uk | Brochure (PDF)
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Applicant  
Family name
Male Female
First name(s)

 
Date of birth
Nationality
Address

Telephone
Mobile telephone
Fax
Email

Special Requirements  
Do you have any medical or special requirements (eg dietry)? If yes, please specify.

Family Information

Parent's name
Father Mother Other
Address
Telephone
Mobile telephone
Fax
Email

Course Details  
Course Ref Letter
Number of weeks
Course name
 
Arrival date
Departure date

Extras

Exam entry (IELTS at £120)

1:1 (at £30 per hour) EFL. Hours per week required:


Transfer  
Do you require a transfer? Yes No
(if yes please tell us)
:
Day and date of arrival
Flight number
From
Airport of arrival
Time of arrival

Payment (Please indicate who will be making the payment)

Payment Details (The deposit should be sent with booking)
Please make payment by bank transfer to:
Lloyds TSB, 82 High Street, Lewes, East Sussex
Sort Code: 30-95-01 • Account No: 03235008 • Acount Name: St George's EnglandIBAN No: GB42LOYD30950103235008 • BIC No: LOYDGB21103

Parent Agent Other
Name for invoicing
Address for invoicing

Any other information

Terms and conditions

To be completed by applicants or parents (if student is under 18 years old)
I have read and agree to the terms and conditions  
Name

 
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