ICC Machida School Information Inquiries Form

Please fill out the form below. We will get in touch with you shortly.

Subject (Required）	Brochure request Trial lesson Course information Others
Full name (Required）
Corporate name
Gender	Male　　Female
Age
Occupation
Nationality
Zip code (Required）
Address (Required）
Telephone number
Mobile phone number
E-mail address (Required）
Purpose of study
Desired language (Required）
Desired course	Private Lessons 　 Semi-Private Lesson 　Intensive lessons 　On-site lessons 　Corporate Language Training Programs 　 Other courses
Comments
How did you know about ICC？	Internet ⇒ 　Google 　Yahoo! Japan 　Other search engine 　Facebook 　NHK textbooks 　 Other magazines 　From friends 　Building sign 　Posters 　Others

For students who would like to take a trial lesson.
What is your proficiency level?	Complete beginner Basic level Intermediate level Higher intermediate level Advanced level
Desired date / time, first preference	Date Month Time
Desired date / time, second preference	Date Month Time
Desired date / time, third preference	Date Month Time
Contact telephone number (Required）
Upon enrollment, how long would you like to study?	Below 1 month ( Intensive courses ) About 3 months 4 months - 1 year I haven't decided yet. Others
When would you like to start?	I would like to start as soon as possible. Within a month. I haven't decided yet. Others
Please indicate the desired days and times.
Comments

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