bulletin d`inscription ecole
Transcription
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