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Summer / Winter ESL Course
Name *
E-mail *
Confirmation*
Country of residence
Nationality (shown in passport) :
Preferred Course
Phone Number
Address
Questions or Comments
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Requested Summer / Winter Program

1) Couse for Summer / Winter Porgram :

2) Number of weeks in your chosen program:

3)Would you like PCTECH to provide accommodation for you?

No
Yes ( YMCA Flushing YMCA Vandarbilt / Homestay )

4) When do you want to begin? (mm/dd/yy)

5) Would you like to have Airport Pickup Service?
No
Yes