| *Name:
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| *Age: |
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| *Date of Birth: |
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| *Gender: |
Male Female |
| *Nationality& Native Language: &
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| *Telephone: |
(Country) / (Area) / (Number) |
| Fax: |
(Country) / (Area) / (Number) |
| *E-mail: |
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| *Confirm E-mail: |
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*Permanent Address:
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Emergency Contact Information :
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Name:
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Relationship:
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| Phone: |
(Country) / (Area) / (Number) |
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E-mail:
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*Accommodation Preferences:
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| Homestay |
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Shared apartments
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| Furnished apartments |
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*Check-in Date:
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*Check-out Date:
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Flight Information:
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| Your Expected Date of Arrival: |
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Arrival Time:
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/hh:mm AM PM |
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*Airport Pick-up:
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Yes (US$45/per order, 4weeks or more homestay free)
No |
| Your Expected Date of Departure: |
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*Airport Drop-Off:
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Yes (US$40/per order)
No |
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*Purpose of Visit:
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| Chinese Study (University) School Study Internship |
| Business Tourism Other |
| Name of School, or Company you'll be attending if you are traveling for education or business? |
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School or Company Address:
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Do you want us to register you? Yes No
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| Level of Chinese speaking ability: Low Intermediate advanced |
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Hobbies and Interests:
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| *Do you smoke? Yes No Sometimes |
Food you cannot eat:
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Do you have a chronic disease? Yes No
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If yes, please explain:
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Are you under a doctor's care at present? Yes No
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If yes, please explain:
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| Are you allergic to anything? Yes No |
If yes, please explain:
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| Would you accept a host with children under the age of 6? Yes No |
| Would you be comfortable with a family that owns a dog? Yes No |
| Would you be comfortable with a family that owns a cat? Yes No |
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| What currency do you prefer to pay by? |
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Use the space provided below for any additional detail about yourself or your trip
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Declaration
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| By entering your name in this box, you are providing an electronic signature: |
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*Name of Applicant :
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*Date:
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Name of Parent/ Guardian (If applicant is under 18 years of age):
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| Date: |
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