Personal information

Name (mandatory)

First name (mandatory)

Date of Birth (mandatory)

Gender(mandatory)
---MaleFemale

Nationality (mandatory)

Mother tongue (mandatory)

Address (mandatory)

Postal code (mandatory)

City (mandatory)

Telephone number (mandatory)

Telephone number 2

This is a 2nd optional number

Telephone number Parents

(Only mandatory when students is younger than 18)

e-mail (mandatory)

e-mail parents

(Only mandatory when students is younger than 18)

Course information

Cours (mandatory)
---IntensiveSummer courseCombi 6Combi 9Combi 12IndividualBeginnerMini-Group

Start date (mandatory)

Number of weeks (mandatory)

Current Level (mandatory)
---- I'm not sure -A0 BeginnerA1 Lower ElementaryA2 Upper ElementaryB1 Lower IntermediateB2 Upper intermédiairC1 AdvancedC2 Profiency
If you are not sure about this, you may fill in an estimate made by you.

Accomodation

Type of accomodation
HostfamilyHomestayBed & Breakfast

Transfer to your residence (hostfamily, B&B, ...)

Would you like to book a transfer to the host family on arrival?
---NoYes
If you answered yes to the previous question, Where do you want to be picked up?

Remarks

I've read and approve the sales conditions (Acceptation is mandatory)
---Ja

(You can find the terms and conditions)