Your first name:
Your last name:
Your email address:
Your address (including postcode):
Country:
Your telephone number:
If we need to call you, when is the best time? (Use your own time zone.)
Day(s) of week:
Time of day:
What duration and start date would you like to book for?
Duration:
5 nights 6 nights 7 nights 8 nights 9 nights 10 nights
Please give your preferred start date:
1st choice: Year:
2008 2009
Month:
Date:
Age group:
Under 15 15-17 18-24 25-34 35-49 50-64 65+
Gender:
Female Male
What is your first language?
Will you be coming alone?
Yes No
If no, who do you plan to come with? (Please make sure that EACH of these people fills in a copy of this form.)
Number of people:
Nobody else 1 other person 2 other people
Name 1:
Relationship to you:
Friend Husband/wife/partner My child My mother/father Other
Name 2:
How would you rate your English ability? Level 0 = complete beginner Level 1 = near-beginner, basic knowledge Level 2 = pre-intermediate Level 3 = intermediate Level 4 = upper intermediate Level 5 = advanced Reading/writing Level 0 Level 1 Level 2 Level 3 Level 4 Level 5 Listening/speaking Level 0 Level 1 Level 2 Level 3 Level 4 Level 5
Where did you find out about Tanuki House? Please select an option and give details (agency, directory name, etc.) in the box on the right.
Friend/acquaintance Leaflet Travel agency Ad in newspaper/magazine Study Abroad Links Other Internet directory
Search engine: Google/Yahoo Search engine: Lycos Search engine: Goo Other search engine Other source
Please give details (agency, directory name, etc.):
Historic places Fun visitor attractions Museums & art galleries Shopping
Cookery Countryside Theatre & music Sports
Other interests:
What kind(s) of English would you like to study? General Travel English Business English Other:
Do you have any other questions, comments or special requests?