Name and Address
First Name:
Surname:
Address:
Telephone:
Fax:
Email:
Date of Birth:	(day, Month, Year)
Nationality:
Country of Birth:
Male:
Female:
Language Course
Choose one of the LAL Schools by clicking one of the buttons.
LALMalta:
LAL Gozo:
LAL Torbay:
LAL Summer Schools England - Kelly College:
LAL Summer Schools England - Taunton School:
LAL Fort Lauderdale:
LAL Summer Schools USA - Lynn University:
LAL Capetown:
LAL Durban:
Course Type:
You can use the grid on pages 34 & 35 of the LAL Brochure to help you select the right course.
Start Date:	(day, Month, Year)
End Date:	(day, Month, Year)
If '0' is beginner and '7' is POST ADVANCED, what is your level? (Please see the brochure page 32 for levels.)
0 1 2 3 4 5 6 7
Arrival:	(day, Month, Year)
Departure:	(day, Month, Year)
Host Family:(Halfboard)
	Single Room
	Shared Room
	Single Room Breakfast Only (LAL Fort Lauderdale Only)
	Shared Room Breakfast Only (LAL Fort Lauderdale Only)
If you select a shared room and already know who you will share with, please state their name here:
Residence/Hotel:
	Single Room
	Shared Room
If you select a shared room and already know who you will share with, please state their name here:
Do you require residence on-suite facilities?:
	Yes
	No
Do you smoke:
	Yes
	No
Do you require non-smoking accommodation:
	Yes
	No
If yes please state reason
Do you have any allergies? (eg. cat hair)
	Yes
	No
If yes then specify:
Any other request regarding accommodation:
Pets , please specify any any animal that you cannot live it:
	Dogs
	Cats
	Reptiles
	Birds
Other? Please specify:
Please give reason:
Do you require a transfer:
	No
	Yes
Arrival
From (Airport):
To (Airport):
On (Date):
On (Flight code):
Leaving at (Time):
Arriving at (Time:)
Departure
From (Airport)
To (Airport):
On (Date):
On (Flight Code):
Leaving at (Time)
Arriving at (Time)
Insurance and Health
(Medical insurance is compulsory in the USA and it is recommended for all other locations)
Would you like Lal travel & medical insurance?:
	Yes
	No
If not please state the name of your insurer:
Policy number:
Special Ref of Instruction
Agency
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