GLOWING RESULTS IELTS

REGISTRATION FORM

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)

 

Surname:    _________________________________________________

 

First name(s): _______________________________________________

 

Postal address in U.K.: ________________________________________

 

E-mail address: ______________________________________________

 

Telephone: _________________________________________________

 

Nationality: _________________________________________________

 

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

 

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How did you hear about Glowing Results IELTS? ___________________

 

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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).

OR

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: _______________