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Please complete the form and proceed to the
FINAL PRICE
page to see the course fee after discount
FAMILY NAME
*
FIRST NAME
*
ADDRESS
*
POST CODE
*
CITY
*
COUNTRY
*
TELEPHONE (in home country)
*
MOBILE (UK)
TELEPHONE (UK)
EMAIL
NATIONALITY
*
PASSPORT No.
*
FIRST LANGUAGE
*
HOW DID YOU FIND US
*
Friend recommended
Newspaper
Callan web-site
Our web-site
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Other
AGE
*
before 14
14 - 17
18 - 21
22 - 25
26 - 30
31 - 35
36 - 40
40+
DATE_OF_BIRTH
*
DO YOU SMOKE
*
Yes
No
SEX
*
Male
Female
Do you regularly take any medications?
*
Yes
No
If ‘Yes’ give details
Do you have any medical condition?
What is your level of English?
*
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
I am not sure
Are you a student?
*
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Year of study:
Subject:
Name of college/University:
Are you working?
*
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No
Occupation:
Course applied for:
Callan Method
Start Date:
Finish Date:
Number of weeks:
Hours per week:
To change the number of weeks and hours please go back to the price list
Study time: from:
to:
EMERGENCY CONTACT
NAME
*
MOBILE/TEL.:
*
EMAIL
ADDRESS
Relation to you
*
Is this your first payment to St. Nicholas College of London?
*
Yes
No
Do you need visa to travel or stay in the UK?
*
(Choose ‘No’ if you are a citizen of EU.)
Yes
No
I have read the instructions for Registration and Payment stated in the Institute’s fee schedule and I have read and accept the
Terms and Conditions
in the Institute’s course brochure .