I/We apply for a place on the Year 2010 Fourth Term Intensive Courses for :

Student's family name:   

First Names:    

Gender: Male Female Date of Birth:

Nationality:

Name of Parent (or guardian):

Home Address:

Email address:

Telephone: Fax:

Number of weeks: 2 4 6 8 Date (from): 07/07/10 21/07/10 04/08/10 18/08/10 (to): 21/07/10 04/08/10 18/08/10 01/09/10

Level of English: none Beginner Elementary Intermediate Advanced

Does your child suffer from any illness or disability? If yes, please give details:

Is there any other information you wish to give us?

Notes:

1. This registration form must be returned to the College together with a non-refundable deposit of £150.

2. Payment may be made by:

a) cheque payable to International College, Sherborne School
b) Bankers draft to Lloyds Bank, 75 Cheap Street, Sherborne, Dorset DT9 3DB to credit of "Sherborne School" account number 01884627 Sort Code 30 99 98 GIVING THE NAME OF THE STUDENT.
c) Recognised Credit Card (VISA Mastercard AMEX)*
IBAN No: GB12_LOYD_3099 9801 8846 27. SWIFT No: LOYDGB2L. BIC No: LOYDGB 21208.

3. The fee must be received by the College in full at least one month before course commencement. (The reservation will automatically be cancelled in the event of non-payment by the due date.)

* Please note that an administration charge of 4% will be added to all Credit Card Payments over £150 (150 pounds).

Please send the fee to:

Director of Intensive Courses
International College, Sherborne School,
Newell Grange
Sherborne, Dorset DT9 4EZ.

Tel: (UK) 01935 814743 (International) 44 1935 814743
Fax: (UK) 01935 816863 (International) 44 1935 816863

Email: registrar@sherborne-ic.net