Enquiry Form
Please complete the highlighted fields
ENQUIRY FORM
--- Fields marked
*
must be completed ---
Name
Email address
*
Contact Number (optional)
Full Postcode (compulsory)
*
Age group
Please Select
18-29
30-49
50+
Number of Students
Please Select
1
2
3+
Purpose of the Course
Please Select
Business
Pleasure
Other
Would you prefer the lessons to take place:
Please Select
at your home/work (smoke free home only)
at tutor's place (RG5 4BA)
either
Would you consider on-line tuition?
Click here for a demo
(will open a new window)
Yes
No
Current level?
Please Select
I do not speak a word
I know a few words (bonjour, je m'appelle, etc.)
I can get by while in France (ie ordering food)
I can hold a simple conversation
I can hold a conversation easily
How many lessons per week would be required?
Please Select
1
2
3
4
5
Duration of each lesson?
Please Select
60mins
90mins
120mins
Frequency of each lesson?
Please Select
weekly
every other week (daytime only)
ad-hoc (daytime only)
Which day(s) would suit best?
*
Tick all that apply
Any weekday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What time(s) would suit best?
*
Tick all that apply
Mornings (9:30 - 12:30)
Afternoons (1:00 - 4:00)
From 4:30pm
From 5:00pm
From 5:30pm
From 6:00pm
From 6:30pm
From 7:00pm
When would you like the lessons to start?
*
As soon as possible
Sometime in the future
(please give more details in the
Comment box
below
)
Comment box
Please add any information you feel might be relevant
Before submitting the form,
please ensure you have read the terms and pricing.
To read Terms
click here
-
(will open a new window)
Security Code:
*
Reload Image
::
PHP FormMail Generator
::
