PERSONAL
DATA
Name:
Surname:
Sex:
Choose M
F
Age:
18
- 22 23 - 25 26
- 30 31 - 35 36
- 40 41 - 45 46
- 50 51 - 60 61
- 70
Phone:
E-mail:
PERIOD
OF YOUR STAY AND INFORMATION ABOUT THE ACCOMODATION REQUIRED
Arrival
date:
Day
1 2 3
4 5 6
7 8 9
10 11 12
13 14 15
16 17 18
19 20 21
22 23 24
25 26 27
28 29 30
31 Month January
February March April
May June July
August September October
November December
Year 2006 2007
No.
of weeks:
Choose 1
week 2 weeks 3
weeks 4 weeks 5
weeks 6 weeks 7
weeks 8 weeks over
8 weeks
Accommodation:
Choose
London Bridge Tower
Bridge Bermondsey Canada
Water Manor House Battersea
Leytonstone Wimbledon
Queen's Park Kilburn
Borough, E. Castle, Clapham
e Camberwell Turnham
Green & Northfields East
Acton, Hanger Lane
Room:
Choose
Single Double
No.
of people:
1
2 3 4
5 6 7
8 9 10
11 12 13
14 15
Please
enter any special agreement number in the box: