| Title |
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| Surname |
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Name |
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| Date of birth |
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| Profession
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| Address |
| Street/Nr |
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| ZIP-Code |
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City |
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| Nationality |
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| Email |
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| Telephone Number* |
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Handy* |
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| *for validity of you registration
and to give us the chance of establishing contact with you, there
must be at least one phone number effective.
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| What is the best time to get in touchwith
you by phone? |
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| Duration of stay: |
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| from
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untill
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| I want to book following course: |
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Standard Course mini-group 20 units / week
Standard Course mini-group Plus 20+5 units / week
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| Approximate level: |
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| Accommodation: |
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| Arrival is on Sunday, the course usually begins
on Monday, and the day of departure is Saturday. Prices for extra
nights are on request. |
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| Smoker / Non Smoker
(Please Choose)
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Smoker |
Non Smoker |
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"I can resign smoking if wished" |
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| Allergies, others |
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| Please tell us how you got to know our organisation.
Thank you! |
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| University
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Search engine in the Internet
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| which one?
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Name?
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| Others |
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