Apply To Become A Student and Learn Legal English

Name:

Date of Birth:

Nationality:

Languages Spoken:

E-mail:

Street Address:

City:

State/Province:

Zip/Postal Code:

Home Phone:

Fax:

Medical Insurance
Policy Number:

In case of emergency contact:

Are you a practising lawyer

yes no

How long have you been
practising and in
what area of law?

If not what is your interest and
experience in legal English?

Do you smoke?

yes no

Are you a vegetarian?

yes no

Your preferences:

About children:

About pets:

About smoking:

Please note that accommodations will be arranged as best as possible to preferences indicated, however choices are not guaranteed.

Please indicate food you can't eat & any allergies you may have:

List the hobbies and activities you enjoy:

I would my Homestay arrangements to begin:

/ /

I would my Homestay arrangements to end:

/ /

Do you require pickup from the airport? yes no

Arrival date:

Airline:

Flight #:

Arrival time:

What are you hoping for in a homestay experience?
Any comments or questions?"

Payment of $400 ($100 homestay registration fee, plus
$ 300 deposit ) may be made by cheque payable to Pacific
Horizons Language Academy or bank transfer. All bank
details will be sent on request. Where payment is made
by bank transfer all charges will be borne by the client.
Payment is required 4 weeks before the commencement
date of the course.

Students Application And Registration