SUMMER COURSE IN ENGLISH PHONETICS 2016 APPLICATION FORM

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SUMMER COURSE IN ENGLISH PHONETICS 2016
APPLICATION FORM
TITLE Prof / Dr / Mr / Ms / Mrs / Miss / Mx (circle one)
SEX
male / female
SURNAME
(family name)
GIVEN NAME
(personal name)
FULL ADDRESS
TELEPHONE NUMBER
EMAIL ADDRESS (please write carefully)
MOTHER TONGUE / NATIVE LANGUAGE
NATIVE COUNTRY
DATE OF BIRTH*
*Your FULL date of birth is required for security purposes
UNIVERSITY DEGREES OR OTHER QUALIFICATIONS (with dates)
PROFESSION / OCCUPATION
Please indicate which type of practical group you would like to be allocated to: (tick one box)
 a) University academics and postgraduates
 d) Other professional people
 b) Teachers of English as a foreign language
 e) IPA examination strand (Only for IPA applicants who
 c) Undergraduate students of English
have completed and passed the entrance test.)
Please indicate how much knowledge of phonetics you already have: (tick one box)
 a) I have a fairly thorough knowledge of the phonetics of English
 b) I have studied English phonetics and know the phonetic symbols, but I need revision / want to build on this elementary
knowledge
 c) I have never studied English phonetics
Please give us an idea of your level of proficiency in English, for example IELTS or TOEFL score / degree / native / other
Please tell us what you mainly hope to gain from this course
Signature
Date
PLEASE TURN OVER: the payment form on the reverse must be completed
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PAYMENT FORM
Credit card payments may be made by completing the form below.
Cheques, or bank drafts, in pounds sterling should be made payable to UNIVERSITY COLLEGE LONDON and sent to the
Department with your application form. Please quote reference number 503728.
Bank transfers (use only for payments sent before 1 June 2016) should be credited to University College London, account
Barclays Bank PLC, 6-17 Tottenham Court Road, W1T 1BE, Account number 40178691, Sort code 20-10-53,
Swift BARC GB 2105L. Transfers must quote our account reference FY38. Check that your bank has included all these details
on the transfer document. Proof of transfer must be enclosed with this application form, which you should send to us when you
make the transfer.
TUITION FEES (tick one box)
EFL strand
IPA strand
 £695
 £780
Total tuition fee paid now: £ …………..
ACCOMMODATION (please complete if you require accommodation; tick one box only)
John Dodgson House (single en suite room with private shower / WC and shared kitchen)
 £516 (twelve nights, arriving 14 August, departing 26 August)
Total accommodation fee paid now: £ …………..
Please tick if you would like us to send a list of local hotels 
PAYMENT METHOD
 I enclose cheque / bank draft, number ………………….………….. for £ ………...., made payable to University College London
 I have arranged payment of £ ………. and enclose a copy of the proof of transfer
 I wish to pay by credit card (please complete the section below)
CREDIT CARD PAYMENTS
I wish to pay by *Visa / *Mastercard; please charge to my account
(*delete as appropriate)
Card number (13 or 16 digits)
Expiry date (month / year, e.g. 01/17)
Security code (3 digits on reverse)
Name (on card)
Address (of cardholder)
Signature (of cardholder)
Total amount to be charged: £ ………….
When complete this form should be sent to:
Summer Course in English Phonetics, Rm 102d, Chandler House, 2 Wakefield Street, London, WC1N 1PF
Fax number: +44 20 7679 4010
If you need advice before you send the form, email: [email protected], or telephone: +44 20 7679 4020
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