GLOWING RESULTS IELTS
We ask for the information below so that we can help you to the best of our ability. The information that you give will be treated confidentially. Please copy this form and e-mail or post it to us in order to book a place.
Title: Mr. Mrs. Ms Miss Dr. Other (please specify)
First name(s): _______________________________________________
Postal address in U.K.: ________________________________________
E-mail address: ______________________________________________
Mother tongue: ______________________________________________
Which of our IELTS courses do you wish to follow?
(a) Reading/Writing (b) Listening/Speaking (c) Both (R/W & L/S)
Have you ever taken an IELTS examination before? Yes No
If so, what were your most recent scores?
a) Reading ___ b) Writing ___ c) Speaking ___ d) Listening ___ e) Overall ___
Do you have any particular reason for taking IELTS? Which grade do you need to achieve?
Do you have any disability which you think we should know about? If so, please specify Yes No
How did you hear about Glowing Results IELTS? ___________________
Please tick as appropriate:
I enclose my deposit* of (a) £25 for a 15-hour course
OR (b) £50 for a 30-hour course
(* Cheques should be made out to Glowing Results. I understand that this is non-refundable if I cancel less than 3 weeks before the start date. I understand that the balance of (a) £155 or (b) £310 is payable 1 week before the start date).
I enclose full payment of (a) £180 for a 15-hour course
(b) £360 for a 30-hour course
I agree either to produce a previous IELTS certificate (original copy) or to take a free Glowing Results test before the start of the course.
I accept the Terms & Conditions as displayed on the web site.
SIGNED: _______________________________ DATE: _______________