Educational Travel Services Reservation Form

 

Your Personal Data: -

  • Male

  • Female

First Name

 
Last Name  
Home Address  
City  
Country  
Telephone  
Mobile  
Email  
Date of Birth  
Your Occupation  
School Name or Employer  
Do you smoke?
  • YES

  • No

Do you have any existing medical conditions or allergies?
  • YES

  • No

If yes, please specify: -  
   
Your Course Information: -
Course Starting Date  
Number of Weeks  
Do you plan to take an Exam?
  • YES

  • No

If yes, please select one
  • TOEFL

  • CAMBRIDGE

  • OTHER

What is your language level?
  • Beginner

  • Intermediate

  • Advanced

Optional Travel House Services  
Do you wish Travel House to Support you with Entry Visa to Selected Country?
  • YES

  • No

Do you wish Travel House to issue you the Travel Insurance?
  • YES

  • No

Do you wish Travel House to arrange your onward transfer from the airport?
  • YES

  • No

   
Signature of applicant   Date  
Signature of parent or guardian   Date  
(if applicant is under 21)