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ONLINE REGISTRATION FORM

WHO AM I?* NEW STUDENTRETURNING STUDENTEXTEND MY STUDYAGENT

STUDENT'S DETAILS

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Last Name*

Date of Birth *

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Email*

Phone*

Nationality on Passport*

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Which VISA you will be travelling with? *

Current Language Ability *

AGENT'S DETAILS

Company Name

Agent Full Name

Email address

Direct Phone Number

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Lexis Language Academy

Course 1

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SEOUL, GangnamSEOUL, HongdaeBUSAN, Seomyeon

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Start date* (You can start your course on Monday only)

Number of weeks*

Course 2

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Not requiredSEOUL, GangnamSEOUL, HongdaeBUSAN, Seomyeon

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Number of weeks

Lexis Support Center

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Message *

I agree I hereby confirm that my payment of the fees as invoiced, in conjunction with my signing of this form, constitutes my acceptance of the terms of my agreement with Lexis Korea in relation to my enrollment. I have read and agree to be bound by all of the Conditions of Enrollment