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ACTILANGUE Ecole Privée de Langue Française
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Enrolment Form Actilangue

 

Family name
First name
Date of birth
Nationality
Sex
Occupation
Street
Street
Post/Zip code
Town
State/Country
Phone
Fax
Email address
How did you hear
about Actilangue?

 

Course

I hereby enrol:
  Course No 2 (25 lessons/week)
  Course No 3 (30 lessons/week)
  Junior Programme
  Extra lessons DELF
   
  Combination Course C25
  Combination Course C30
   
  Private Course EI20
  Private Course EI25
  Private Course EI30
  Private Course EI40
  Private Course EI50

Date of the course
Duration (weeks)
Promotion code

 

Accommodation

I wish to live with a family

Date of arrival
Date of departure
Transfers



Time of arrival
Flight/Train No

 

I wish to live in the Flat/the Residence:

Number of persons
Date of arrival
Date of departure

 

I wish to live in the apart'hotel:

Number of persons
 
Date of arrival
Date of departure

 

I wish to live in the hotel:

Date of arrival
Date of departure

 

Knowledge of the French Language


 

Comments

 

Payment of the deposit (150 €)

Bank transfer for Actilangue:
BNP PARIBAS - 5 bis Place Masséna - 06000 Nice - France
Account No: 000 151 114 62-85
IBAN : FR76 3000 4000 3800 0151 1146 285
BIC : BNPAFRPPNIC
 
Cheque (in EURO)
 
Postal order (cash)
 
Credit card (Visa/Mastercard)
Credit card No (without spaces):
Valid thru:
Last 3 numbers on the back of the card:
Card holder:

 



 

 

 

 

  
 

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