Limerick Language Centre

First Name: *

Surname: *

Nationality: *

Passport No:

Gender: *

Date of Birth: *

Email: *

Phone: *

Course Details: *

GE-20 Standard (Full-time Mornings)

GE-30 Intensive (Full-time Mornings & Afternoons)

GE-20 + 5 Combination (Full-time Mornings + 1-to-1 lessons x 5)

GE-20 + 10 Combination (Full-time Mornings + 1-to-1 lessons x 10)

FCE-30 Full-time Mornings + Afternoons (GE-20 + FCE-10)

CAE-20 (Full-time mornings)

IELTS-30 Full-time Mornings + Afternoons (GE-20 + IELTS-10)

AY-IELTS Academic Year

AY-FCE Academic Year

AY-CAE Academic Year

GE-10 Part-time Afternoons (1pm-3.30pm)

IELTS-10 Part-time Afternoons (1pm-3.30pm)

FCE-10 Part-time Afternoons (1pm-3.30pm)

GE-11 Mon/Wed Part-time Evenings (7pm-9pm)

GE-11 Tues/Thurs Part-time Evenings (7pm-9pm)

FCE-11 Mon/Wed Part-time Evenings (7pn-9pm)

FCE-11 Tues/Thurs Part-time Evenings (7pm-9pm)

CAE-11 Mon/Wed Part-time Evenings (7pm-9pm)

CAE-11 Tues/Thurs Part-time Evenings (7pm-9pm)

Start date of course *

End date of course *

Number of Weeks

End-of-programme Exam Registration fee for Academic Year programmes - €200 (not necessary for EU/EEA students) *

Before programme starts

After programme starts

Not necessary for me (I have EU/EEA passport)

Medical Insurance for Academic Year programmes - €110 *

Yes

No

English Level *

Online Test Result: *

Accommodation Details: *

Do you have any allergies or medical conditions we should be aware of?

Do you smoke?

Yes

No

Is there any food you cannot eat?

Arrival Date in accommodation:

Departure Date from accommodation:

Number of Weeks

Do you require local arrival transfer? *

Yes, I would like your driver to meet me on arrival in Limerick City centre

Yes, I would like your driver to meet me on arrival in Shannon Airport

No, I can go to my accommodation myself

No, I already live in/near Limerick

Arrival Details: