Telephone: (514) 509-4242 Fax: (514) 509-1622 Email: info@miila.ca

Registration Online

 

 

Instructions: Please complete the entire form in English. When the form is complete, hit the “Submit” button to send the form to M.I.I.L.A.

Personal Information

First Name (required)

Last Name (required)

Your Email (required)

Address 1:

Address 2:

City:

State-Province:

Zip-Postal Code:

Country:

Telephone:

Fax:

Country of Birth:

Date of Birth:

Gender:
 Male Famale

Native Language:

Will you be applying for a study Permit?:
 Yes No

Who will pay for your course?:
 Self / parents Others, please specify

Emergency contact, full name:

Emergency contact, telephone #:

How did you hear about M.I.I.L.A?:
 Internet Print advertisement Word of mouth Friend / former student Agent Educational fair, please specify:

Program information

Course Start Date: (dd/mm/yyyy):

Course End Date: (dd/mm/yyyy):

Total number of weeks:

How many hours per week?:
 Premium Super Intensive (36 lessons/week) Premium Intensive (27 lessons/week) Semi-Intensive (18 lessons/week) Evening (9 lessons/week) Private

Current language level:
 Beginner Intermediate Advanced

Accommodation Information

Will you require accommodation?

From (dd/mm/yyyy):

To (dd/mm/yyyy):

for weeks:

and days:

Family language:
 English speaking French speaking

Do you smoke?
 No Yes

Do you have allergies?
 No Yes

Do you take daily medication?
 No Yes

Is there any food you cannot eat?
 No Yes

Spicify:

Can you live with children?
 No Yes

Would you mind to live with pets?
 No Yes

Airport Transfers

Will you require airport Transfer?

Please specify the arrival information:

Health insurance

Will you require medical insurance?
 No Yes

From (dd/mm/yyyy) :

To(dd/mm/yyyy) :

for weeks :

and days:

PAYMENT INFORMATION

The payment of the CAD$100 registration fee is required in order for M.I.I.L.A. to process your registration.

Payment option

 Credit card

 Money order, traveler's cheques or certified cheques in CAD$

Make payable to Montreal International Institute of Language Arts. Mail to:

Montreal International Institute of Language Arts, M.I.I.L.A.
1220 Mackay Street
Montreal, Quebec
H3G 2H4
Canada

 Wire transfer in CAD$

Wire payment to:

Montreal International Institute of Language Arts
Account number: 5215961
Branch number: 05271
SWIFT number: TDOMCATTTOR
TD Canada Trust
999 De Maisonneuve Blvd. West
Montreal, Quebec. H3A 3L4. CANADA
Fax: +1 (514) 847-8955

Please read our Refund and Cancellation Policy before submitting your application.

LINK >> Refund and Cancellation Policy.

 I have read and understood the refund and cancellation policy. I have read and understood the program costs. I am over 18 years old. By submitting this form, I hereby agree to these terms.