TOEIC EXAM APPLICATION FORM
Personal Details
First Name
Family name
Date of Birth
month
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Address
Postcode
Nationality
Phone Number
e-mail address
Exam Date Requested
please select
16 April 2008
30 April 2008
14 May 2008
28 May 2008
13 June 2008
27 June 2008
18 July 2008
25 July 2008
1 August 2008
15 August 2008
22 August 2008
5 September 2008
19 September 2008
1 October 2008
15 October 2008
29 October 2008
12 November 2008
26 November 2008
10 December 2008
TOEIC Preparation Course
Yes
Number of Weeks
weeks
Number of hours
per week
15 hours
30 hours
Start Date
month
January
February
March
April
May
June
July
August
September
October
November
December
year
2006
2007
Would you like a certificate?
Yes
No
Would you like us to post the result to your UK address?
Yes
No
How would you like to pay for the exam?
Cash
Credit Card
Debit
Solo
Switch
*Credit Card payment - 3% extra charge
How did you find out about our TOEIC test centre?
Flyer
Newspaper : Name of newspaper
Magazine : Name of magazine
Bloomsbury international prospectus
Notice board
Website : Name of website
Search engine : Name of website
Friend / word of mouth
Other : comment
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