30 July, 2001 5:08 PM
 
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Agent Booking

Please ensure that you have all the information needed as incomplete forms cannot be processed.

(Should we put address and contact details in?)
Agent Name:
Agent ID:
   
Group Booking Name:
Group Booking ID:
Number of students:
Commission rate:
   
1. NAME AND ADDRESS  
Family Name:
First Name:
Title:
Gender:
Date of Birth:  (e.g. 1978)
Nationality:
Country of Birth:
E-mail:
Tel:
Fax:
Address 1:
Address 2:
State/Province:
Country:
Zip/Postal Code:
   
2. FLIGHT DETAILS  
Arrival Details:  
Arrival Airport:
Flight no:
Time:
Date:
Departure Airport:
Departure Details:  
Departure Airport:
Flight no:
Time:
Date:
Arrival Airport:
Departure Airport:
Do you require a transfer? Yes
   
3. LANGUAGE COURSE
Start Date:
End Date:
Language Course:
Language level:
(If "1" is Complete Beginner and "7" is proficient)
1 2 3 4 5 6 7
   
4. ACCOMMODATION
Arrival Date:
Departure Date:
Hotel/Residence:
  Single Room Double Room
  Shared with:
   
Host Family Single Room Shared Room
  Do you smoke? Yes No
  Do you have any allergies? Yes No
  Please give details
  Do you need a special diet? Yes No
  Please give details
   
SPECIAL REQUESTS
To Top If you are sure that all information is correct
   
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