Amic Lesson Application Form

************************************************************************ Would you like to enjoy learning English at Amic English Center？ If you would like to take lessons at Amic English Center, please complete the form below. Upon receiving this form, our staff will contact you directly by telephone or email. ************************************************************************

◆Name　 ◆Age　years ◆E-mail (Please enter accurately)　 ◆Post code　 ◆Address ◆TEL　 ◆Your English level 　 Select a level Beginner Elementary (simple conversation) Intermediate (conversationally fluent) Advanced (can discuss major issues) ◆Desired course 　 Select a course General English course Children's course Parent/child course Senior Citizens' course Exam Preparation Course Overseas Travel Prep. Course English movie course Interpretation Course ◆Other enquiries/information　(※If you hold any English qualifications, please specify) 　 　 ************************************************************************ Upon completion of the above form, please press the Confirm button. The Send button will then appear. Press the Send button to send the application. Thank you for applying to Amic English Center. ************************************************************************