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Adult Programme - Customised

Family Name*

First Name*

Street Address*

City*

State/Province

Postal Code

Country:

Date of Birth*

Email Address*

Your Start Date

Your End Date

Gender
Male Female

Which English language course would you like? *

a) Micro-Gen 20 (20 Micro-group General English Lessons per week. Average 4, max 6 students)
How many weeks?

	2 weeks only	Extra weeks, special rate
September - June	€580	€260
July + August	€650	€280

b) Micro-Gen 20 + 6 (20 Micro-group General English + 6 'one to one' lessons per week)
How many weeks?

	2 weeks only	Extra weeks, special rate
September - June	€990	€470
July + August	€1050	€498

121PT One to One Private Tuition (General English) €45/hr
Hours/Week for Weeks

121PT One to One Private Tuition (Business English) €50/hr
Hours/Week for Weeks

121PT Two to One Private Tuition €30/hr
Hours/Week for Weeks

Leisure programme *
Our GENERAL LEISURE PROGRAMME is designed by our leisure team and always tries to inlcude some sporting, cultural and creative activities in the 3 afternoons. Ticking boxes does not guarantee inclusion but gives us an idea of what kind of activities you like and we always do our best to keep most of the participants happy. (General Leisure Programme at €98/wk)

Kayaking Golf Arts and Crafts Tennis Sailing lessons Horse riding Scuba Diving Irish music lessons Irish history and archaeology Beach and countryside walks Socialising in a traditional Irish pub Enjoying Live Music Trips to the Cinema Irish Dancing Excursions by bicycle

Opportunity to also take part in an additional full day excursion at the weekend - €45*
How many weekend Excursions?

What is your accommodation preference?*

(a) Host Family
How many weeks?

Weekly Rates	Standard	Self-Catering	Executive
September - June	€160	€105	€195
July + August	€170	€115	€220

(b) Guest house, Bed & Breakfast accommodation. Includes full Irish breakfast.

Standard at €55/night How many nights?
Superior at €80/night How many nights?
Hotel at €90/night How many nights?

Accommodation arrangement fee €20

Are you a first-time applicant? If yes, add registration fee of €45
Yes No

Will you require airport transfer? (€85/each way-Cork, €90/each way-Kerry)
Yes No

Tell us about yourself.

What do you hope to achieve by the end of the course?

Your level of English is?
Beginner Intermediate Advanced

What skills do you hope to improve?

Do you have any allergies?
Yes No

If so please elaborate. e.g cats, dust etc

Do you smoke?
Yes No

Any special dietary needs?
Yes No
If so please elaborate

To book your place on a course, we will need to secure an advance deposit (25%). After completing and submitting this application form we wil require proof of a payment transfer to the account below. Or, you may also pay by credit card Visa, Amex, MasterCard (phone or fax details in confidence). Full remaining fees can be paid at any time up to 3 weeks before arrival. Please note that cancellation prior to arrival may incur an administration fee.

Bank account details for transfer of deposit/fees:

Bank name & address: AIB Bank, Main Street, Schull, SW Cork, Republic of Ireland.
Account name: Atlantic English Language Services
IBAN number: IE21AIBK93636703239094
Swift:AIBKIE2D

Terms Agreement


Revised on: 12 April, 2007

CANCELLATIONS
Bookings may be cancelled up to 3 weeks prior to commencement of  the course  but you will lose the 25% booking deposit. For cancellations received between 14-21  days before commencement of course 60% of full amount will be refunded; for cancellations received 1 - 7 days before commencement of course 30% of full amount will be refunded. No refund for any cancellation after the course has commenced.  This includes days missed during the course, late arrival or  early departure.  In some circumstances we may allow you to continue your course at a later date at no extra cost. Long term students may discuss  taking some holiday weeks during their course and  only a retainer fee for accommodation  will be charged. There lessons will then recommence on their return with no lesson weeks lost.

REFUNDS
I understand that all fees and charges will not be refunded after my course starts.  I am aware, however, that Atlantic S.E.A.L will allow me to continue my course at a later date should unavoidable circumstances cause premature departure.
	
INSURANCE
* Insurance is the responsibility of the course participants. Students should arrange medical insurance in their own country before departure. EU students should bring E111 forms.

* Travel insurance is also recommended.

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Atlantic School of English and Active Leisure, Cooradarrigan, Schull, County Cork, Ireland.
Telephone: +353 (0) 28 28943 Fax: +353 (0) 28 28946