Language Course Application Form for Annecy

Language Course Application Form

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SUMMARY

SECTION 1. PERSONAL DETAILS

Fill in the application form on-line. Please answer all

questions. All fields marked with an * are required and

must be completed

Once your application has been received you will be given

a reference N° that you will need to quote on all

correspondence, e-mails or when contacting us by

telephone

We offer on-line secure credit card payment. . We also accept cheques and bank transfers.

First Name*

Last Name*

Date of Birth*

Place of Birth

Age:*

Gender:*

Home Tel N° (country code first)

Work Tel N° (country code first)

Mobile Tel N° (country code first)

Fax N° (country code first)

E-mail

Address Line 1*

Address Line2

City*

County/State*

Zip/Postal Code*

Country*

Next of kin (if different from above) Address Line 1:

Next of kin Address Line 2:

Next of kin City:

Next of kin County/State:

Next of kin Zip/Postal Code:

Next of kin Country:

Next of kin Tel N°: (country code first)

Nationality:*

What is your mother tongue?*

How do your rate your current level of the language?*

Do you: smoke?*

Date of arrival:*

Date of departure:*

Language course required:

Sporting activities required (to make multiple choices hold down the ctrl key)

Other useful information: (allergies, particular diet etc)

SECTION 2. ACCOMMODATION

Choice of Accommodation:*

Host Family: Hotel: Residence:


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