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REGISTRATION FORM
ACCORD
ECOLE DE LANGUES – PARIS

SUMMER COURSE PROGRAMMES (Summer Courses for Juniors & Family Programme)
1st of July to 25th of August 2012
PARENTS’ DETAILSParent 1 Parent 2
First name: First name:
Last name: Last name:
Nationality: Nationality:
Date of birth: Date of birth:
Address:
Tel:
Fax:E-mail: E-mail:
If attending a course, please select:
Course Type: Semi-Intensive 15 h □ Semi-Intensive 15 h □
Course Type: Intensive 20 h □ Intensive 20 h □

Level of French: Level ofFrench:
Date of Course:
From: From:
To: To:
Course Duration: weeks weeks

-------------------------------------------------
TOTAL ADULT COURSE FEE:-------------------------------------------------
Price per week:
-------------------------------------------------
Total course price (including all adult courses):

CHILDREN’S DETAILS

Number of childrenattending the Summer course:
CHILD no. 1 CHILD no. 2 CHILD no. 3
First name: María José First name: First name:
Last name: Marquina Last name: Last name:
Nationality: MexicanNationality: Nationality:
Date of birth: 28/08/1993 Date of birth: DD/MM/YYYY Date of birth: DD/MM/YYYY
Gender: Female Gender: Gender:
Level of French: B1 Level of French: Level of French:Course Type:
Semi-Intensive 15h X Semi-Intensive 15h □ Semi-Intensive 15h □
Intensive 20 h □ Intensive 20 h □ Intensive 20 h □
Date of Course:
From: July 16 From: From:
To: July 27 To:To:
Course Duration: 2 weeks weeks weeks

-------------------------------------------------
TOTAL CHILDREN SUMMER COURSE FEE:
-------------------------------------------------
Priceper week: EUR
-------------------------------------------------
Total course price (including all children courses):



ACCOMMODATION
We wish to book our accommodation through ACCORD at the...
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