Lydbury English Centre - Agent Data Collection
 

If you would like to work with us to send students to Lydbury English Centre, please fill in this questionnaire. We will contact you to discuss terms and conditions and well as commission.

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1. Please enter your name:

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2. What is the name of your agency?

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3. What is the name of the person for us to contact at your agency?

4. Have you ever visited Lydbury English Centre?

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5. General enquiry email

6. Your personal email (if different)

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7. Telephone

8. Your personal telephone (if different)

9. Fax

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10. Address Line One

11. Address Line Two

12. Address Line 3

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13. City

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14. Post Code

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15. Country

16. Your facebook identity (if you have one) - ours is LydburyEnglishCentre

17. Your Twitter identity (if you have one) - ours is @lydbury

18. Your Skype identity (if you have one) - ours is lydbury

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19. Please link me in to your Lydbury website

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20. Please add me to your agent contacts on the English in Britain website

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21. Please add me to your monthly newsletter distribution.

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22. Please consider me for inclusion in your next monthly newsletter. My text is in the box below. [Please note there is no charge for inclusion in our newsletter and there is no guarantee that we will include you.]

23. Please put any further comments here.