bulletin d`inscription ecole

BULLETIN D’INSCRIPTION ECOLE
Enrolment form school
Mrs
Miss
Mr
NOM : ………………………….…….
PRENOMS : ……………….…..
Surname
First names
Photo récente à
fixer
Photo to fix
E-mail : ……………………………………………………..
DATE DE NAISSANCE : _ _ /_ _ /_ _ _ _
NATIONALITE : …………….………........................
Date of birth
Nationality
ADRESSE: …………………………………………………
TELEPHONE : _ _ _ _ _ _ _ _ _ _ _ _ _
Address
Phone
………………………………………………………………….
PROFESSION/ETUDES : ……………………………..
PROFESSION DES PARENTS: …………………….
Profession/studies
How did you heart of ADEL PROVENCE? …………………………………
Profession of parents for students under 18 years
BARAERLIN LANGUES ? ……………………………….
NIVEAU LINGUISTIQUE
DEBUTANT
Level of language
Beginner
INTERMEDIAIRE
AVANCE
Intermediate
Advanced
NOMBRE D’ANNEES D’ETUDES EN FRANCAIS : ……………… DIPLOMES EN FRANCAIS: …………………………………………
How long have you been learning French?
Obtained diplomas in French
DEBUT DES COURS : _ _ /_ _ /_ _ _ _
DATE DE DEPART : _ _ /_ _ /_ _ _ _
NOMBRE DES SEMAINES : ………………
Course start date
Date of departure
Number of weeks
TYPE DE COURS:
Course type
20 lessons / week
25 lessons / week
Private courses
30 lessons / week
Private hours / week ………
HEBERGEMENT Accommodation
Accueil en famille:
Chambre simple
Double chambre
Host family
Single room
Double room
Chambre d’hôte :
Chambre simple
Guest rooms
Single room
ADDITIONAL:
Double chambre
Double room
Résidence universitaire
University residence
Reception and transfers railway station
Reception and transfers Airport:
Assistance, a regular follow up of your stay from 15 years old
Search of activities not included at school
LOISIRS / ACTIVITES Recreation / Activities in aditional
Plongée sous marine
Voile / motonautisme
Tennis
Equitation
Œnologie
Diving / Underwater sports
sailing / Motor sports
Tennis
Horse riding
Oenology
Gastronomie
Cooking
Vacances
Holidays
ECOLE BARAERLIN LANGUES : 40 Rue Borde 13008 Marseille France Tel : + 33 (0)4 91 47 96 79 + 33 (0)6 15 44 68 90 Fax : + 33 (0)4 91 30 66 89
SARL AU CAPITAL DE 4 000 € SIRET 483 665 311 R.C.S.MARSEILLE APE 804D
ADEL PROVENCE : 23 Rue Edmond Dantès 13004 Marseille France Mail : [email protected] www.adel-provence.com
The form must be returned, accompanied by a cheque / bank draft of 320 € made payable to «
BARAERLIN LANGUES » .
Virement Bancaire : CREDIT LYONNAIS 87 Rue Paradis 13006 MARSEILLE – France
IBAN : FR47 3000 2028 3400 0007 1695 F24
BIC / SWIFT : CRLYFRPP
Titulaire: BARAERLIN N° compte: 2834 0000071695F
Code Banque : 30002 / Code Guichet : 02834 / clé R.I.B. 24
By cheque in euros, payable in a French bank and send to BARAERLIN, 40 RUE BORDE 13008 Marseille
France.
On receipt of your « Enrolment Form », we will send to you the document entitled « Confirmation of
Application », which constitutes the contract between ADEL PROVENCE and you, to be used for
eventual reimbursement.
I PAY AN INSTALLMENT OF 320 €
I PAY THE TOTALITY OF: ………. €
Enrolment registration
I,……………………………………………………….. the undersigned, declare the exact information given
herewith and declare to be fully aware of and totally accept the terms of the general conditions which
have been submitted and which I acknowledge
to be in my possession.
Signed at………………………………………..on…………………
Signature (parent’s or guardians signature for students under 18 years of age)
ECOLE BARAERLIN LANGUES : 40 Rue Borde 13008 Marseille France Tel : + 33 (0)4 91 47 96 79 + 33 (0)6 15 44 68 90 Fax : + 33 (0)4 91 30 66 89
SARL AU CAPITAL DE 4 000 € SIRET 483 665 311 R.C.S.MARSEILLE APE 804D
ADEL PROVENCE : 23 Rue Edmond Dantès 13004 Marseille France Mail : [email protected] www.adel-provence.com