ONLINE ESL Class Request Form

Barry Murrell November 1, 2014 ONLINE ESL Class Request Form2014-11-12T18:35:09+00:00

For more information on this program, please visit the product page or make a general inquiry.

(In filling out this form you are NOT making a commitment to pay anything!)

Contact Information

NOTE: Items marked with * are required.

First Name*:

Last Name*:

Age*: 18-25 26-35 36-49 50+

Address:

City:

Province:

ZIP/Post Code:

Country* :

Telephone #:

Cell #:

Email Address*:

SKYPE Name*:

** You MUST have a SKYPE name because we only use SKYPE for our classes!

Preferences:

How many minutes do you want for each class?
10 Minutes
20 Minutes
30 Minutes
45 Minutes
60 Minutes <<< Best Value!

What kind of teacher do you want?
American native speaker
Filipino teacher

Do you want Skype classes with video or just the audio without the video?
Skype with video.
Skype with audio only.

How often do you want to have classes?
Once a week.
Twice a week.
Three times a week. <<< Our recommendation!
Four times a week.
Five times a week.

What time would you like to have your class?

How often do you plan to pay for your classes? (Minimum of 5 lessons required!)
I will pay for 5 lessons at a time (NO Discount)
I will pay for 10 lessons at a time (5% Discount)
I will pay for 20 lessons at a time (10% Discount!) <<< Best Value!

** Remember that your first class is FREE!
** You pay nothing until AFTER your free class!
** We will send you a PayPal billing invoice once your enrollment is confirmed!
** We currently only accept payment through PayPal !

What is your main goal for these classes? (Please include any questions you might have.)

How did you hear about ETHOS?

Newspaper
Website (Website name?)
Friend (Friend’s name?)

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