INSTRUCTIONS:
Fill in the application
form on-line. All fields marked with a
*
are required and must be completed
Once your
application has been received you will be given a reference N °
that you will need to quote on all correspondence, e-mails or when
contacting us by telephone
We will contact you within 24 hours to confirm your booking
First
Name*
Last Name *
Home Tel N°
(country
code first)
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Work Tel N°
(country
code first)
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Mobile Tel N°
(country
code first)
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Fax N°
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E-mail
Address Line 1 *
Address Line2
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Zip/Postal Code *
Country *
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Unlisted
Venezuela
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Next of kin
(if different from above) Address Line 1:
Next of kin
Address Line 2:
Next of kin
City:
Next of kin
County/State:
Next of kin
Zip/Postal Code:
Next of kin
Country:
Albania
Algeria
Andora
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Belarus
Belgium
Bosnia-Herzegovina
Botswana
Brazil
Bulgaria
Cameroun
Canada
Canary Islands
Cayman Islands
Chile
China
Colombia
Costa Rica
Croatia
Cyprus
Cezch Rupublic
Cezchslovakia
Democratic Republic of Congo
Denmark
Dominician Republic
Ecuador
Egypt
El Salvador
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Ghana
Greece
Greenland
Guatemala
Holland
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kenya
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malasyia
Malta
Mexico
Monaco
Mongolia
Morocco
Nambia
New Zealand
Nigeria
Norway
Pakistan
Panama
Peru
Phillipines
Poland
Portugal
Romania
Russia
Salvadore
San Marino
Seychelles
Singapore
Slovak Republics
Slovenia
South Africa
South Korea
Spain
Swaziland
Sweden
Switzerland
Taiwan
Tanzania
Thailand
Togo
Trinidad and Tobago
Turkey
Uganda
Ukraine
United Kingdom
United States of America
Unlisted
Venezuela
Yugoslavia
Zambia
Zimbabwe
Next of kin
Tel N°
(country
code first)
-
Nationality: *
Albania
Algeria
Andorra
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Belarus
Belgium
Bosnia-Herzegovina
Botswana
Brazil
Bulgaria
Cameroun
Canada
Canary Islands
Cayman Islands
Chile
China
Colombia
Costa Rica
Croatia
Cyprus
Cezch Rupublic
Cezchslovakia
Democratic Republic of Congo
Denmark
Dominician Republic
Ecuador
Egypt
El Salvador
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Ghana
Greece
Greenland
Guatemala
Holland
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kenya
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malasyia
Malta
Mexico
Monaco
Mongolia
Morocco
Nambia
New Zealand
Nigeria
Norway
Pakistan
Panama
Peru
Phillipines
Poland
Portugal
Romania
Russia
Salvadore
San Marino
Seychelles
Singapore
Slovak Republics
Slovenia
South Africa
South Korea
Spain
Swaziland
Sweden
Switzerland
Taiwan
Tanzania
Thailand
Togo
Trinidad and Tobago
Turkey
Uganda
Ukraine
United Kingdom
United States of America
Unlisted
Venezuela
Yugoslavia
Zambia
Zimbabwe
Marital Status *
Married
Divorced
Living together
Seperated
Single
Religion:
Gender: *
Male
Female
Age: *
D.o.B. :*
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31
Jan
Feb
Mar
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July
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Oct
Nov
Dec
Profession:: *
Arrival Date: *
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Jan
Feb
Mar
Apr
May
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July
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Sept
Oct
Nov
Dec
2002
2003
Departure Date: *
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Jan
Feb
Mar
Apr
May
Jun
July
Aug
Sept
Oct
Nov
Dec
2002
2003
N° of nights
required: *
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31
N° of people: *
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02
03
04
05
06
07
08
09
10
Do you smoke? *
Yes
No
If you smoke
would you be willing to smoke only outside the host family's home? *
Yes
No
Are you willing to go to a family with
animals? *
Yes
No
Type of accommodation: *
Host Family
Accommodation on a Farm
Pre-Booked Tour
Tour As You Go
Tour of North England
Type of room? *
Single Room
Double Room
Category: *
Standard
Superior
Luxury
Reason of visit:
Work
Pleasure
Study
If student name of school:
If you are doing a work experience name
of employer:
Do you require a babysitting service? *
Yes
No
Any other relevant information which
you feel is important: (allergies, particular dietary
requirements etc):
How did you find our web site? ? * Please quote
Ref N °
if applicable
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