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Office of Early Childhood Education and Child Care

English Language Academy, Dublin, Ireland

Online Application Form

 

 Name: 

 E-mail: 
 Passport N°: 

 Phone Number: 
 Sex: 
Male    Female

 Date of Birth: 

 Address: 
 Country: 

 My native language is: 

 I wish to study English for: 
  Years    Months    weeks

 I wish to register in: 
 
 Other Course: 

 Date you wish to start Course: 

 Any medical conditions:   
 If yes, please state: 

 Do you require medical insurance?   

 Person to contact in case of an emergency: 
 The person speaks English:   

 Do you require accommodation?   
 If yes, please state: 

 How long do you require accommodation for? 

 Please state date of arrival: 

 Do you require airport pick up on arrival?   


See the English Language Academy Refund Policy
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Please Note:
            All Course Fees must be paid in full with this registration.
            Valid Photo ID (Passport, Driver’s License) must also be presented.

Bank A/C Details:
            Bank of Ireland, College Green, Dublin 2.
            IBAN Code: IE54 BOFI 90001782178012 BIC/ SWIFT Code BOFIIE2D
            Account Name: English Language Academy (ELA)

Please complete this form and return with full fees to Director of Studies, English Language Academy, (ELA), 73 Capel St, Dublin 1, Ireland or email it to info@elaireland.com along with proof of payment.

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