A&E Quality Education Services Centre 14-888 West 16th Street North Vancouver, BC V7P 1R3 Canada Phone: 1-604-725-4725 Fax: 1-604-929-6644 E-mail: aeqesc@telus.net Personal Information First Name Family Name Gender Male Female Date of Birth: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year Your e-mail Your Address: Street City Province/ StatePostal code Country Phone: Area code Something about yourself This information will help us to give you better service in your school or Student-house: (optional) Where did you hear about us? Agent Internet Friend Embassy Advertisement Other: When do you want to start your course? Your English level is: Beginner intermediate Upper-Intermediate Advanced Please give us your flight number, Airline, Arrival Date and time: