Atlantique Language Galway

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Book a Course

Book a course

Personal Details

Family Name*

First Name*

Gender*

Date of Birth (day/month/year)*
/ /

Address Details

Address

City

Post Code

Country

Email Contact Details

Email*

Confirm Email Address*

Phone Contact Details

Phone Type*

Country Code

Area Code

Phone Number

Nationality*

Native Language*

Course Booking Details

Course Name	Start Date	End Date

What is your English level?	How long have you studied English?

Accommodation Booking Details

Atlantic Language Galway offers two types of accommodation for individual students, Host Family (home-stay) and School Apartment accommodation.

[1] Host Family

[2] School Apartment

[3] No Accommodation

Standard Room

Single Room

Accommodation is not required for my booking

En-suite Room

Single Room En-suite

Double Room
(for 2 sharing)

Twin Room
(for 2 sharing)

Twin Room En-suite
(for 2 sharing)

Accommodation Dates
Date of arrival at accommodation	Date of departure from accommodation
Special Requests and Considerations
Do you have any allergies?	Do you have any physical restrictions?
Do you have any dietary requirements?	Any special requests or comments?

Travel Details

Arrival in Ireland	Departure from Ireland
Arrival Airport	Departure Airport
Flight Number	Flight Number
Transfer Service Request	Transfer Service Request

Confirm Booking

I want to use a Special Offer Voucher Number for this booking

	Enter the Voucher Number here

I will pay by: Credit Card Bank Transfer
(payment details will be sent with your invoice)

I have read and accept the terms and conditions of booking.*

The information I have given on this booking is correct to the best of my knowledge at the time of booking.*

To book a course place at Atlantic Language Galway please complete the Course Booking form on the left.

To help us to process your booking as quickly as possible please complete your booking form as fully as you can.

Fields marked * are required: you must provide some information for these fields.

Your email details are important as we will confirm your booking and generally communicate with you by email.

* English Level: Atlantic Language Galway does not offer courses at Beginner or Proficient levels

Please select the accommodation type you require, either Host Family (home-stay) or School Apartments. If you do not require accommodation please choose option 3.

Note that Accommodation Dates for apartment bookings must be from Saturday to Saturday

Let us know if you have any special considerations or requests to be accommodated with your booking

If you know what your travel plans are please complete this section.

Let us know if you require an airport meeting or transfer service.

Take a moment to check your booking and make sure that the details are correct, then tick the boxes and send your booking.

If you have received a Special Offer Voucher Number from Atlantic Language Galway you can enter this in the Voucher box on the left. Please make sure that your voucher is still valid and enter the number correctly so that you can receive your special offer