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)