e-mail：

For further information please check one.

pls. provide information by mail will inquire personally
　

Personal Information:

Please answer the following questions :

Questionnaire

Your answer to the questions below will be used as our reference.

How did you know about Dela Cruz English Club?

through friends
Advertisement [ newspaper: magazine: ]
Pamphlets
Poster/leaflet [ Specific place: ]
Passer-by
Others :

Incentives for those who refer DCEC to others

We highly appreciate referrals. Those who will recommend DCEC will be given special incentives.

REFERRAL:

　Name:
　Tel. no. ／E-mail ）
　Contact Address:

Can be contacted through :

Mail Phone or E-mail
others

Suggestions/Questions

Suggestions and inquiries are most welcome.