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A&E Quality Education Services Centre
Tel: 604-929-6644
Toll-free: 866-423-7372
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First Name:
Last Name:
Gender
Male
Female
Date of Birth :
Address:
Postal Code:
City:
Country:
Phone:
E-Mail Address:
Where did you hear about us:
Website
Search engine
Referral
Embassy
Advertisement
Fair
Friends
Other
The course you are looking for :
English as a second Language (ESL)
Computer
Technical
Medical
High school
College
Other:
Please write your note, comments or additional information about your course and your level:
Do you need Home-stay :
Yes
No
If yes:
Do you smoke?
Yes
No
Problem with Pet?
Yes
No
Allergies?
Yes
No
if yes explain
Your Flight detail:
Flight No.
Flight Date
Air Line
Add any extra information that can help us to find the right home-stay for you.
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