Registration form - French language school Millefeuille Provence

YOUR DETAILS

Name

Surname

Cellphone (only)

Profession

Age

Nationality

Adress

Oral comprehension

Written comprehension

Oral expression

Written expression

Programme

Full board accommodation

Dates

Lenght of stay (in weeks)

Payment method

Bank transfer

VISA

Eurocard Mastercard / AMEX

Amount to charge

Card number

Expiration date

Cryptogram

Comments