Agent Name : $agentname"; } } else { $hear="Not Specified."; } if($_POST['acc_choice_1']!='') { $acc1=$_POST['acc_choice_1']; } else { $acc1="Not Specified."; } if($_POST['acc_choice_2']!='') { $acc2=$_POST['acc_choice_2']; } else { $acc2="Not Specified."; } if($_POST['acc_weeks']!='') { $acc_weeks=$_POST['acc_weeks']; } else { $acc_weeks="Not Specified."; } if(($_POST['acc_start_dd']!='default') && ($_POST['acc_start_mm']!='default') && ($_POST['acc_start_yy']!='default')) { $accstartdate=$_POST['acc_start_dd']."-".$acc_mm=$_POST['acc_start_mm']."-".$acc_yy=$_POST['acc_start_yy']; } else { $accstartdate="Not Specified."; } if(($_POST['acc_end_dd']!='default') && ($_POST['acc_end_mm']!='default') && ($_POST['acc_end_yy']!='default')) { $accenddate=$_POST['acc_end_dd']."-".$_POST['acc_end_mm']."-".$_POST['acc_end_yy']; } else { $accenddate="Not Specified."; } $smoke=$_POST['smoke']; if($_POST['special_require']!='') { $spreq=$_POST['special_require']; } else { $spreq="Not Specified."; } if(($_POST["arrival_dd"]!='default') && ($_POST["arrival_mm"]!='default') && ($_POST["arrival_yy"]!='default')) { $arrdate=$_POST['arrival_dd']."-".$_POST['arrival_mm']."-".$_POST['arrival_yy']; } else { $arrdate="Not Specified."; } ($_POST["arrival_time"]!='')?$arrtime=$_POST['arrival_time']:$arrtime="Not Specified."; ($_POST['airport']!='')?$airport=$_POST['airport']:$airport="Not Specified."; ($_POST['flightno']!='')?$flight=$_POST['flightno']:$flight="Not Specified."; ($_POST["taxi_require"]!='')?$atransfer=$_POST['taxi_require']:$atransfer="Not Specified."; $insurance=$_POST['insurance']; ($_POST["course_total"]!='')?$course_total=bcadd($_POST['course_total'],0,2):$course_total=0.00; ($_POST['acc_total']!='')?$accom_total=bcadd($_POST['acc_total'],0,2):$accom_total=0.00; ($_POST["other_total"]!='')?$ototal=bcadd($_POST['other_total'],0,2):$ototal=0.00; $ptotal=bcadd($_POST['pay_total'],0,2); $pmethod=$_POST['pay_method']; $cname=$_POST["cname"]; $caccname=$_POST["caccname"]; $caccno=$_POST['caccno']; $cverfno=$_POST["cverfno"]; if($_POST["cissueno"]!='') { $cissueno=$_POST["cissueno"]; } else { $cissueno="Not Required."; } $startdate=$_POST["s_month"]."-".$_POST["s_year"]; $expdate=$_POST['e_month']."-".$_POST["e_year"]; $securityno=$_POST['bank_transfer_secno']; $reg_date=date("d-m-Y"); $table='
Application Form
 
1. Personal Details
 
First Name : '.$prefix.' '.$firstname.'
Family Name : '.$familyname.'
Nationality :
'.$nationality.' Date of Birth : '.$dob_dd.'-'.$dob_mm.'-'.$dob_yy.' (dd-mm-yyyy)
Home Address : '.nl2br($homeaddress).'
Telephone No. : '.$tel.'
Mobile No. : '.$mobile.'
Fax No. : '.$fax.'
E-mail : '.$email.'
 
What is your level of English ?
'.$level.'
 
2. Course Details
 
Couser Name : '.$coursename.'
Other : '.$other.'
Number of Weeks studying : '.$nweeks.'
Course Start Date : '.$course_dd.'-'.$course_mm.'-'.$course_yy.'(dd-mm-yyyy)
Course End Date '.$cousreenddate.'(dd-mm-yyyy)
 
3. How did you hear about UIC?
 
'.$hear.'
 
4. Accommodation (Complete if required)
   
 
Accommodation Choice : 1.
'.$acc1.'
2. '.$acc2.'
Number of weeks of accommodation '.$acc_weeks.'
Accommodation Start '.$accstartdate.'(dd-mm-yyyy)
Accommodation End '.$accenddate.' (dd-mm-yyyy)
Do you smoke? '.$smoke.'
Do you have any allergies or
Special Requirements / Preferences
eg. no pets, children, food restrictions 		'.$spreq.'
   
5. Arrival Information
 
Arrival Date : '.$arrdate.' (dd-mm-yyyy)
Arrival Time : '.$arrtime.'
Airport : '.$airport.'
Flight Number : '.$flight.'
 
6. Airport Transfer
 
Do you require a taxi from the airport?
'.$atransfer.'
 
7. Insurance
 
Do you require Insurance? ( see www.uiclondon.com )
'.$insurance.'
 
8. Payment
 
Course Registration Fee £ 20
  Total / Deposit £ '.$course_total.'
       
Accommodation Finding Fee £ 30
  Total / Deposit £ '.$acc_total.'
Other ( Specify )   £ '.$ototal.'
Total   £ '.$ptotal.'
       
Please indicate payment method?
'; if($pmethod=='Credit Card') { $table.=$pmethod."
"; $table.="Credit Card Name : ".$cname."
"; $table.="Name on Credit Card Name : ".$caccname."
"; $table.="Credit Card Number : ".$caccno."
"; $table.="Card Verification Code : ".$cverfno."
"; $table.="Switch Card Issue Number : ".$cissueno."
"; $table.="Start Date : ".$startdate."
"; $table.="Expiration Date : ".$expdate."
"; } else if($pmethod=='Bank Transfer') { $table.=$pmethod."
"; $table.="Security No : ".$securityno; } else { $table.=$pmethod; } $table.='
 
I have read the Terms & Conditions for 2005 on the attached sheet and the above details are correct.
    Date : '.$reg_date.'
 
'; //Mail To UIC //$header= "MIME-Version: 1.0\r\n"; $header="From: info@uiclondon.com\r\n"; $header.="Bcc: tejash@fiplindia.com,uic@fiplindia.com\r\n"; $header.="Content-type: text/html \r\n"; // $body=$table; $to="enquiry@uiclondon.com"; //$to="direct@uiclondon.com"; //$to="uic@fiplindia.com"; //$to="adrian.ryan@gen2group.com"; //$to="tarik@fiplindia.com"; //$to="brijesh@fiplindia.com"; mail($to,"Student's registration detail!",$table,$header); //Mail To Client //$header="MIME-Version: 1.0\r\n"; $header="From: info@uiclondon.com\r\n"; $header.="Content-type: text/html\r\n"; $body='
Dear '.$prefix.' '.$firstname.' '.$familyname.',
Thank you for registering with UIC.
'; $to= $_POST["email"]; mail($to,"Your registration at UIC!",$body,$header); $msg="You are registered successfully!
Thank you for your interest in UIC!"; } if(isset($_POST["mSubmit"])) { $prefix=$_POST['prefix']; $firstname=$_POST['firstname']; $familyname=$_POST['familyname']; $nationality=$_POST['nationality']; $dob_dd=$_POST['dob_dd']; $dob_mm=$_POST['dob_mm']; $dob_yy=$_POST['dob_yy']; $homeaddress=$_POST['homeaddress']; $tel=$_POST['tel']; if($_POST['mobile']!='') { $mobile=$_POST['mobile']; } else { $mobile = " - "; } if($_POST["fax"]!='') { $fax=$_POST['fax']; } else { $fax=" - "; } $email=$_POST['email']; $mlangname=$_POST["mlangname"]; if($mlangname=='Other') { $mlangname="Other : ".$_POST["mlangnameother"]; } $mlanglevel=$_POST["mlanglevel"]; if($_POST["weeks"]!='') { $nweeks=$_POST['weeks']; } else { $nweeks=" - "; } $course_dd=$_POST['course_start_dd']; $course_mm=$_POST['course_start_mm']; $course_yy=$_POST['course_start_yy']; if(($_POST["course_end_dd"]!='default') && ($_POST["course_end_mm"]!='default') && ($_POST["course_end_yy"]!='default')) { $cousreenddate=$_POST['course_end_dd']."-".$_POST['course_end_mm']."-".$_POST['course_end_yy']; } else { $cousreenddate="Not Specified."; } ($_POST["course_total"]!='')?$course_total=bcadd($_POST['course_total'],0,2):$course_total=0.00; ($_POST['textbook']!='')?$textbook=bcadd($_POST['textbook'],0,2):$textbook=0.00; $ptotal=bcadd($_POST['pay_total'],0,2); $pmethod=$_POST['pay_method']; $cname=$_POST["cname"]; $caccname=$_POST["caccname"]; $caccno=$_POST['caccno']; $cverfno=$_POST["cverfno"]; if($_POST["cissueno"]!='') { $cissueno=$_POST["cissueno"]; } else { $cissueno="Not Required."; } $startdate=$_POST["s_month"]."-".$_POST["s_year"]; $expdate=$_POST['e_month']."-".$_POST["e_year"]; if($_POST["hear"]!='') { $hear=$_POST["hear"]; if($hear=='Other') { $agentname=$_POST["agent_name"]; $hear.="
Other : $agentname"; } } else { $hear="Not Specified."; } $reg_date=date("d-m-Y"); $table='
Application Form
 
1. Personal Details
 
First Name : '.$prefix.' '.$firstname.'
Family Name : '.$familyname.'
Nationality :
'.$nationality.' Date of Birth : '.$dob_dd.'-'.$dob_mm.'-'.$dob_yy.' (dd-mm-yyyy)
Home Address : '.nl2br($homeaddress).'
Telephone No. : '.$tel.'
Mobile No. : '.$mobile.'
Fax No. : '.$fax.'
E-mail : '.$email.'
 
2. Language
 
  '.$mlangname.'
3. Level
'.$mlanglevel.'
Number of Weeks studying : '.$nweeks.'
Course Start Date : '.$course_dd.'-'.$course_mm.'-'.$course_yy.'(dd-mm-yyyy)
Course End Date '.$cousreenddate.'(dd-mm-yyyy)
 
4. Payment
 
  Course £ '.$course_total.'
  Textbook £ '.$textbook.'
  Total £ '.$ptotal.'
       
Please indicate payment method?
'; if($pmethod=='Credit Card') { $table.=$pmethod."
"; $table.="Credit Card Name : ".$cname."
"; $table.="Name on Credit Card Name : ".$caccname."
"; $table.="Credit Card Number : ".$caccno."
"; $table.="Card Verification Code : ".$cverfno."
"; $table.="Switch Card Issue Number : ".$cissueno."
"; $table.="Start Date : ".$startdate."
"; $table.="Expiration Date : ".$expdate."
"; } else if($pmethod=='Bank Transfer') { $table.=$pmethod; } else { $table.=$pmethod; } $table.='
 
5. How did you hear about UIC?
 
'.$hear.'
 
I confirm that the above details are correct.
    Date : '.$reg_date.'
 
'; //$header= "MIME-Version: 1.0\r\n"; $header="From: info@uiclondon.com\r\n"; $header.="Bcc: tejash@fiplindia.com,uic@fiplindia.com\r\n"; $header.="Content-type: text/html \r\n"; $body=$table; if($mlangname=='Spanish' || $mlangname=='French' || $mlangname=='Italian') { $to="languages@uiclondon.com"; //$to="adrian.ryan@gen2group.com"; //$to="unnati@forteit.com"; //$to="direct@uiclondon.com"; } else if($mlangname=='Chinese' || $mlangname=='Japanese') { $to="asia@uiclondon.com"; //$to="adrian.ryan@gen2group.com"; //$to="unnati@forteit.com"; //$to="direct@uiclondon.com"; } else { $to="languages@uiclondon.com"; //$to="adrian.ryan@gen2group.com"; // $to="unnati@forteit.com"; //$to="direct@uiclondon.com"; } mail($to,"Student's registration detail!",$table,$header); //Mail To Client //$header="MIME-Version: 1.0\r\n"; $header="From: info@uiclondon.com\r\n"; $header.="Content-type: text/html\r\n"; $body='
Dear '.$prefix.' '.$firstname.' '.$familyname.',
Thank you for registering with UIC.
'; $to= $_POST["email"]; mail($to,"Your registration at UIC!",$body,$header); //Mail To UIC $msg="You are registered successfully!
Thank you for your interest in UIC!"; } ?> UIC - Teaching language courses
 
   Home     About UIC     Courses     Accommodation     FAQ     Links     Contact Us     Register 
 
 
">

Application Form

Select one for which you want to apply :
Select Language :
For which English Course :

query($query); $db->next_record(); ?>
1. Personal Details
   
 
Mr Ms Miss Mrs Title
  First Name
  Family Name
  Nationality
Date of Birth :
  Home Address
  Telephone No.
  Mobile No.
  Fax No.
  E-mail
   
  What is your level of English?
 
  What is your level of f("name");?> ?
 
  ( See brochure for details )
     
2. Course Details
     
  Select Course : query( $query); ?>
     
  Other
     
  Number of Weeks studying
 
Course Start Date
Course End Date
     
3. How did you hear about UIC?
     
  Agent
 
Friend Internet Travel/Study Guide Magazine Walked in
     
4. Accommodation (Complete if required)
   
 
Accommodation Choice
1.
2.
Number of weeks of accommodation
Accommodation Start
Accommodation End
Do you smoke?
Yes No
Do you have any allergies or
Special Requirements / Preferences
eg. no pets, children, food restrictions
   
5. Arrival Information
     
  Arrival Date
  Arrival Time
  Airport
  Flight Number
     
6. Airport Transfer
     
  Do you require a taxi from the airport?
 
Yes One-Way Return No
     
7. Insurance
     
  Do you require Insurance? ( see www.uiclondon.com )
 
Yes No
     
8. Payment
     
 
Course Registration Fee £ 20
  Total / Deposit £
       
Accommodation Finding Fee £ 30
  Total / Deposit £
Other ( Specify )   £
Total   £
       
  Please indicate payment method?
  Sterling Cheque
  Cash
 

Credit Card
   
Name on Credit Card:* Credit Card Name:*
Credit Card #:*
Card Verification Code:*
Switch Card Issue:*
Start Date:*
Expiration Date:*
 

Bank Transfer

    To:

Languages in London
20-71-64
40585815
Barclays
27 Regent Street
SW1Y 4UB


SWIFT CODE - BARCGB22
IBAN GB70 BARC 2071 6440 5858 15
   
Security No. :  
    ( last three digit located in the signature strip on the reverse of your card )
     
     
    I have read and I agree with the terms and conditions for 2006 on theattached sheet and the above details are correct.
   
 
">

Application Form

Select one for which you want to apply :
Select Language :
For which English Course :

1. Personal Details
   
 
Mr Ms
  First Name
  Family Name
  Nationality
  Date of Birth :
  Home Address
  Telephone No.
  Mobile No.
  Fax No.
  E-mail
   
     
2. Language
     
  Spanish  
Japanese  
French  
Chinese  
Italian  
Other  
  Other
     
3. Level
     
 
C. Beginner  
Beginner Plus  
Elementary  
Pre- intermediate  
Low-intermediate  
Intermediate  
Upper-intermediate  
Advance  
One to one  
Other  
     
  Number of Weeks studying
     
 
Course Start Date