Personal Details
Title Mr Mrs Ms Dr Sex Male Female
First Name Date of Birth
Surmame Occupation
Address Nationality
Native Language
Do you Suffer from any illness/disability Yes No
Do you have any dietry needs Yes No
Do you have any allergies Yes No
City Do you smoke Yes No
Post Code Please give details
Country  
Telephone Number

 
country code
area code
number
Fax Number
 
country code
area code
number
Email



Passport Details

Passport Number Place of issue
Date Of Issue Date of Expiry

Course Details
Course Staring Date Course Finishing Date
Course Type What is your level of English

Accomodation Details
Do you require Accomodation Yes No Accomodation Finishing Date
Accomodation
Starting Date		 If you do not need accomodation, please provide us with address of residence


Flight Details
Do you require airport transfers Yes No Departure Date
Arrival Date Departure flight no.

Arrival time

 Departure time


Payment Details
Registration Fee Euros 40.00
Course Fee

Accomodation fee
BB/HB/FB supp.
Airport Transfers
Other
Total due

(If you have difficulties in computing to the total amount due, please send us an email with your detailed
request and we will forward you with the cost for the pakage you requested)
Deposit - 25% of Total due


Method of Payment
Please choose your prefarred method of payment and follow the respective intructions
Bank Transfer
a. Print and complete the above enrolment form
b. Advise your bank to debit our account with the full deposit amount (i.e. you are to pay all bank charges)
  Name of bank Bank of Valletta
Branch Ballutta
  Address Manwel Dimech Str. Sliema
  Account Number 11808931014
  Swift Code VALL MINT
  Account Name Clubclass Co. Ltd.
c. Send us the completed enrolment form together with a copy of the bank transfer slip
 
Banker's Cheque
a. Print and complete the above enrolment form
b. Issue an international banker's cheque in favour of Clubclass Residential Language School
c. Send us the completes enrolment form together with the international banker's cheque
 
Credit Card
a. Print and Complete the above enrolment form
b. Complete the following details:
 
Credit Card Type
VISA
MASTER CARD
EUROCARD
OTHER (please specify)
  
Credit Card Number  
Card Holder's name Amount  
Signature as on Card      
c. Send us the completed enrolment form.