register First Name Last Name Address Postal/Zip Code Country Home Telephone Work Telephone Fax EMail Address Gender Male Female Age Occupation Nationality First Language Other Languages Spoken Allergies, dietary requirements or special requests Smoking I smoke I do not smoke I will accept a family that smokes Interests and Hobbies Are you registering for one or two students? One student Two Students Name of student with whom you will study. *Applications only accepted if students have a similar level of English and register together Type of course General English Business English English for Exams Other How many lessons per week would you like? 15 lessons per week 20 lessons per week 25 lessons per week Type of programme Standard One-to-One-Plus Preferred Location London Oxford English South coast United States Date of Arrival [dd/mm/yy] Date of Departure [dd/mm/yy] Additional Information/Requests: Level of Spoken English (0 beginner, 9 fluent) 0 1 2 3 4 5 6 7 8 9 Level of Written English (0 beginner, 9 fluent) 0 1 2 3 4 5 6 7 8 9 How long have you studied English? Why do you need to study English? How did you hear about Live in Languages? Indicates Response Required
