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English Conversation Circles Registration Form Winter 2012

Name: ____________________________________________

For Office Use Only:

Email Address: _____________________________________


Home Address: _____________________________________
__________________________________________________

Wednesdays, 11:00am-Noon (beginner)


Thursdays, 11:00am-Noon (advanced)
Thursdays, 7:00-8:00pm (intermediate)

Postal Code: _______________________________________


Phone Number: _____________________________________

Notes:

Native or Home Language(s): __________________________

Please tell us why you would like to participate in the English Conversation Circles:
__________________________________________________________________________
__________________________________________________________________________
Where did you hear about the English Conversation Circles? _________________________

How would you rate your level of spoken English?


Beginner
1

Intermediate
2

Advanced
4

How would you rate your level of written English?


Beginner
1

Intermediate
2

Advanced
4

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