Omnicom school of languages


	Toronto School

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Course & Homestay Registration Form

Personal Information
First Name
Last Name
Sex (M or F)
Date of Birth (yy/mm/dd)
Nationality
Address
City/Town
Province/State
Postal Code
Country
Telephone
Fax
E-Mail
Where did you hear about Omnicom?

Course Information
Language Level
Program Applying For

Duration of Study
Type of Program:
I would like to start (yy/mm/dd) and study for
weeks in:

Homestay Information
Would you like Homestay?
I would like homestay starting from (yy/mm/dd)
to (yy/mm/dd) for weeks and days.
Do you smoke?
Pet preference?
How many meals?
Placement preference:
Please indicate any special dietary needs or medical concerns:

Airport Pick up Information
Would like airport pick-up?
Arrival Date:	(yy/mm/dd)
Arrival Time:
Airline:
and Flight number

Minimum deposit: four-week course fee, plus first four weeks of homestay (if applicable) and $120 registration fee.

I, the undersigned, wish to register for studies at Omnicom and agree to abide by the rules and conditions of the Omnicom school of Languages.