BRISBANE CAMPUS

LEVEL 1, 232 ADELAIDE STREET, BRISBANE, QUEENSLAND, 4000 TEL: 07.3220.0144 FAX: 07.3220.0277 CRICOS CODE: 02137M info@ilsc.com.au www.ilsc.com.au

SYDNEY CAMPUS
LEVEL 6, 540 GEORGE STREET, SYDNEY, NSW 2000 TEL: 02-9247-1744 FAX: 02-9247-1644 CRICOS CODE: 02753J info@ilsc.com.au www.ilsc.com.au

PUBLIC TOEIC APPLICATION

TEST DATES
Friday, 18 January 2013 Friday, 15 February 2013 Friday, 15 March 2013 Friday, 12 April 2013 Friday, 10 May 2013 Friday, 07 June 2013 Friday, 05 July 2013 Friday, 02 August 2013 Friday, 30 August 2013 Friday, 27 September 2013 Friday, 25 October 2013 Friday, 22 November 2013 Friday, 13 December 2013

Applications, including payment, must be

received two weeks before the test.

TEST DATE SELECTION

- Test date must match a date from the list on this page -

PROGRAM COSTS

MAIL my I will pick up my certificate at certificate to the address below ILSC

TEST FEE Listening & Reading (incl. 1x report with photo) TEST FEE Listening & Reading (incl. 1x report with photo & certificate) Extra Official Certificate Extra Official Score Report with photo Postage-Registered Post
Please check at the time of registration)

$ 180.00 $ 210.00 $ 50.00 $ 45.00

$ 180.00 $ 210.00 $ 50.00 $ 45.00 $

Conditions of Registration
1. 2. Your registration is accepted only after the test fee has been paid. If you wish to change your test date, 2 weeks notice must be given in writing or you will forfeit all fees. Rescheduled tests must be within 12 months of payment. Refunds are not available after 12 months. Additional fees may be required. Late examinees will not be admitted into the test and will not receive refunds or postponed tests. Cancellations 14 days or more prior to the test will incur a 20% administration charge. Cancellations less than 14 days prior or after the day of the test, no refund will be given. Examinees must present official photo identification (passport) on the test day or they will not be allowed to take the test. Examinees who fail to bring current passport size photo will still be able to take the test but no photo will be provided in the score report nor will a refund be given.

TOTAL PAYMENT

(Australian Dollars)

3.

PERSONAL INFORMATION Family Name Given Names Date of Birth d/m/y Mailing Address

3.

Sex: F

4. 5. 6.

7.

Telephone E-Mail AGREEMENT

All information given on this application is correct and complete. I accept the conditions of registration described on this page.

Office use only:

Payment Yes No Receipt Number

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signature

date (dd / mm / yy)