AccentWorks International (SM)

Please answer the following questions. We will contact you by e-mail or telephone with any questions and/or limitations that may exist in scheduling. Further instructions will be given at that time. Denotes a required field.

Your name:

E-mail address:

Telephone number:

For telephone programs, please indicate the telephone number you wish us to call for sessions.

What program are you interested in?

What mode of transmission are you interested in?

Individual or group sessions?

For group only

Are you signing up with an additional person, or persons, to be in your group or would you like us to place you in a group?

Additional person(s) Sign me up for a group

If you are signing up with additional person(s) in your group, please list name(s) of the other participant(s):

(Additional person(s) must sign up as well.)

For instruction only

If you are interested in an instructional program, is 1 one-hour session per week agreeable to you?

Yes No

If no, please indicate what arrangements you would prefer:

Are you in the U.S.?

Yes No

If you are in the U.S., what time zone are you in?

If you are outside the U.S., what city and country are you in?

Based on your local time, what days and times are you available for
scheduling?

What is your native language?

How long have you been speaking English?

Who referred you? (We will provide one hour of free private instruction to a preexisting client who referred you—certain restrictions apply. If a client referred you, please list his/her name.)

What are your goals or reasons for this accent reduction program?

Any further comments/questions?

1.800.977.3324