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Penang English Adventure Interest Form
First name
*
Last name
*
Gender
*
Male
Female
Non-binary
Email
*
Phone
*
Is this phone number connected to WhatsApp?
*
Yes
No
Current English Level
*
Beginner (0 - early A1)
Elementary (early A1)
Pre-intermediate (A2)
Do you want to stay with a host family
*
Yes
No, I will arrange my own accommodation and food.
How many are travelling in your group?
*
How many weeks do you want to Study English
*
1 Week
2 Weeks
Other
Proposed Arrival Date (if known). Plan to arrive on a Saturday or Sunday.
Month
Day
Year
Time
:
Hours
Minutes
AM
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