application form

::::: How to enrol :::::

Fill in the application form and click "send".
Pay in full to secure your place.
A place can not be reserved until full payment is made.

We accept payment by:

Cash Only by visit

Sterling Cheque Please make payable to JCLA Ltd.

Credit Card VISA / MASTER / JCB
(Telephone order acceptable)

Bank Transfer HSBC Bank Plc.
133 Regent St,London W1A 4BQ
Sort code 40-06-02
Account No. 31481991
Account Name: Japan
Centre Language Academy

*Please send a copy of your bank transfer by fax.
*Please inform your bank that you will pay the bank charges.

Upon receipt of your payment, a letter of confirmation will be sent to you.

* Please note that the course fee is only valid for the person and dates.

[Cancellation Policy]
Deposits and course fees are in all cases non-refundable.
Full tuition fee is refundable if the school cancels the course.

first name

surname

age

sex	men　woman

date of birth	date month year

e-mail address

address
postalcord

tel

level of english	(Please state if your first language is not English.)

occupation

choice of course	Aromatherapy
	reflexology
	Beauty Therapy
	Holistic Massage
	Indian Head Massage Course
	Anatomy & Physiology Course
	Introduction Course

Thank you