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First Name: * |
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Address Details: |
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Street: * |
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City: * |
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Post Code: * |
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E-Mail: * |
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Company Name |
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How did you hear about Berlitz Study Abroad |
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Accommodation: |
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Host Family:- All package programmes include host family accommodation. Homestay accommodation includes two meals per day (breakfast and dinner) unless otherwise stated on this application. Host family accommodation can also be arranged for students purchasing their programmes a la carte. Please provide us with the following information to assist us in selecting suitable host family accommodation for you. |
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Arrival Date: |
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Airline and flight number, date and time of arrival: |
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Total number of nights: |
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Yes:
No:
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Yes:
No:
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If "Yes" please describe |
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Yes:
No:
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(If so, a supplement will be payable for the additional accommodation and meals required.) |
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Please tell us something about yourself to help us select the host family for you (i.e. special interest, itinerary, business, profession, special dietary requirements etc.): |
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| Accommodation for A La Carte Programmes: |
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Host Family : |
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Hotel : |
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Self Catering : |
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Bed and Breakfast : |
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Desired Programme: |
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The Globetrotter:
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The Explorer: |
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The Traveler: |
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The Voyager: |
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Total Immersion Instruction: |
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Full day Individual Instruction: |
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Half day Individual Instruction: |
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Semi Private Instruction: |
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Half day Group Instruction: |
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Full day Group Instruction |
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Beginner: |
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Intermediate: |
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Advanced: |
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Final Certification:
I agree to be responsible for tuition and fees as well as all other incidental costs incurred by me including, but not limited to, host family fee, telephone calls, airport pick up and any damages due to my actions. |
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