Students Online Registration Form

Name

Address

City

Code

Country

Phone

Fax

E-mail

Area Required

Preferred Examples:

Choice 1 Host ID:

Choice 2 Host ID:

Choice 3 Host ID:

Nationality

Arrival Date: Departure Date:

Rooms Required: Single Double

Accommodation: Standard    Superior

Category: Bed & Breakfast Half Board Self Catering

Smoking: Yes   No

Transport: Public Own

Allergies or Medical Problems

Address of School or Work Placement if Appropriate

Reason For Stay

Comments

How did you hear about our service ?

How do you want to send us your Credit-Card information?

Online via Fax by Phone

Credit Card Name:       Visa      MasterCard    Other Credit Card

Credit Card No:           Expiry Date:

Important! If you have a security problem, you can send us your Credit Card information using our print out Fax Form, or telephone us during UK office hours on +44 (0)20 7385 9922