University of Wales, Bangor

UNIVERSITY OF WALES, BANGOR ENGLISH FOR BUSINESS COURSE 2006 APPLICATION FORM

I wish to take part in the English for Business Course at the University of Wales, Bangor. Course Date: 31st July - 11th August 2006  14th August - 25th August 2006 

Course Price: £420.00  My Family Name(s)…………………………………………………………………….

My First Name(s)……………………………………………………………………….

Male  Female  Date of Birth …………………………

My first language is ………………… My Nationality is ……………………………

My address is: ………………………………………………………………………….

………………………………………………………………………………………….

…………………………………………………………………………………………..

My e-mail address is (if available) ……………………………………………………..

Do you wish to book accommodation? Self-catering en-suite: £ 79.10 per week Bed & Breakfast en-suite: £115.85 per week Accommodation will be available from the Saturday before your course begins until 9.30am on the Saturday after your course. ROOMS MUST BE VACATED BY 9.30am on the SATURDAY (FAILURE TO MOVE OUT ON TIME WILL CAUSE PROBLEMS FOR THE NEXT PERSON MOVING INTO THE ROOM) Yes  Self-catering in a University Hall of Residence: en suite  Bed and Breakfast in a University Hall of Residence: en-suite

No 

Would all applicants please answer the following questions:

Do you have any medical condition we should know about? ………………………….

Where did you find out about our course? :......

My level of English is: elementary  intermediate  advanced  (Please tick)

I have studied English for ……….. years.

£100 Booking Fee is required. A place on the course will not be reserved without the booking fee which will be deducted from your course fee.

Course Fee and Accommodation Fee should be paid before or on the FIRST DAY of the course (Monday) in the ELCOS General Office.

You can PAY for the course and accommodation by bank draft, bank transfer or credit card payment. BANK DRAFT  Bank Draft should be made payable to: ELCOS, UWB

BANK TRANSFER  Please quote Full Name for reference and make sure that the transfer indicates that the payment is for ‘an ELCOS course’. Account Name University of Wales, Bangor ELCOS Account Address Barclays Bank Plc 273 High Street Bangor Gwynedd LL57 1RU Account Sort Code 20-35-47 Account Number 80975907 Iban Number GB09 BARC 20354780975907 Swift Code BARC GB 2280975907  Please make sure that you pay the Bank Transfer Charges when sending the payment.  Email Income Officer : [email protected] to confirm payment is being made into University Account

CREDIT CARD PAYMENT Type of Credit Card (please tick box) Mastercard  Visa  Card Number

(Card Number - this is the long number across the centre of the card)

Issue Expiry Security code Date / Date / (last 3 digits on signature strip) (Security Code – last 3 numbers on the back of the card) DECLARATION I authorise you, to charge my CREDIT CARD account for £ ______(pound sterling). (write amount in BLOCK LETTERS) ______I will advise you in writing immediately if the card becomes lost, stolen or if I wish to close my card account or cancel the authority.

Signature of cardholder ______Date ______

 When you have completed and signed the form, please return it to: ELCOS, University of Wales, Bangor Bangor, LL57 2DG United Kingdom Telephone: (01248) 382153/382252 Fax: (01248) 383784

Booking Conditions A deposit of £100 must be sent with the application. The deposit will only be refunded if cancellation is made at least 28 days before the start date of the course. In such a case the deposit, minus an administration charge of £50, will be refunded. Once a student has arrived in Bangor to start the course, payment of the complete course fee must be made on day one of the course and no refund can be given. Students who arrive late must pay the full cost of the course.

I apply for a place on this course and I agree to the booking conditions:

Signed: ...... Date: ......  Your booking will be confirmed by post.  Have you remembered to enclose your £100 booking fee? We cannot reserve a place without the booking fee which will be deducted from your course fee.  Have you remembered to state the amount you wish to pay if paying by credit card and signed to authorise transaction.