First Name ……………………................
Family Name ………………….................
Sex …………………….............................
Date of Birth ………………….................
Passport Number ……………..................
Nationality…………………….................
Address……………………………..........
……………………………………………
……………………………………………
……………………………………………
Country…………………………………..
E-mail…………………………………….
Phone…………………………………….
Fax………………………………………..
……………………………………………
COURSE…………………………………
Course code..…………………………....
Course description…………………........
…………………………………………….
QUANTITY OF WEEKS ………………..
1 …………………………………………..
2…………………………………………...
3…………………………………………...
4 …………………………………………..
More………………………………………
…………………………………………….
ACCOMMODATION……………………
Home Stay………………………………....
Hotel……………………………………….
No accommodation required………...........
……………………………………………..
I AM A SMOKER………………………..
Yes…………………………………………
No……………………………………….....
ANY SPECIAL REQUEST ……………....

WHAT IS YOUR LEVEL OF LANGUAGE

Elementary………………………………...
Pre-Intermediate…………………………..
Intermediate……………………………….
Upper-Intermediate……………………….
Advanced…………………………………..
……………………………………………..
TRANSFER (from and to airport)
I need………………………………………
I don’t need………………………………..

FLIGHT DETAILS……………………….
Arrival (time local)………………………..
Flight number……………………………..
Airport…………………………………….
Departure (time local)…………………....
Flight number……………………………..
Airport…………………………………….

YOUR INTERESTS, HOBBIES ………..

COURSE DATES………………………..
From………………………………………
To…………………………………………
For………………………….weeks with………………lessons per week

HOW DID YOU HEAR ABOUT OUR SCHOOL?
From a friend……………………………

At a travel agency………………………
On the internet (from Web-site)……….

I have read the school policy (Terms and Conditions)on the site www.mahavis.com and I agree with all the conditions.
Signed……………………………………..

Now please print this and send it to us by post or fax it to (+44)01424 465599