IS Aix-en-Provence - Application form :

Enrolment form

Attention: all fields followed by * must be completed, and it is imperative that the e-mail address is valid to continue the enrolment procedure.

Etape 1/3 : Your particulars

Personal information

Civility	Mr Mrs/Miss
Surname *		First name *
Date of birth * (DD,MM,YY)		Nationality
Occupation
Adress 1 *		Adress 2
Postcode *		City and state *
Country *
Telephone		Fax
E-mail *

If we have to invoice your company:

Name of company or organisation
Adress 1		Adress 2
Postcode		City and state
Country
Name of contact
Function of contact
Telephone		Fax
Contact's e-mail address

Step 2/3: Your request

Your level

Select your level *
To evaluate your level, go to the European Council reference grid. We invite you the evaluation tool Dialang developed with the support of the European Commission.

What is your mother tongue?
Useful information What other language(s) do you speak? How long have you studied French? Are you studying french at the moment?
Have you ever come to IS?*	Yes No - if yes when
How did you find out about IS Aix-en-Provence? *

Course choice *

I would like to enrol in the following course(s)
Français Général (FG)	and
Français Général + (FG+)	and
Français Général & Cours Particuliers (FGCP)	and


Français Général Découverte de la Cuisine Provençale (FGDCP)
Français Général Découverte de la Provence Autrement (FGDPA)
Français Général Découverte de l'Oenologie (FGDO)
Français Général & Ateliers de peinture (FGAP)
Français Général & Randonnée (FGR)
Français Général & Voile (FGV)
Français Général & Golf (FGG)	2010 Dates at your convenience
Français Général & Equitation (FGE)	2010 Dates at your convenience
Français Trimestriel / 8 weeks minimum (FT) (cf. 1 & 2)	and
Français Général et Français Professionnel (FGFP)
Français Professionnel (FP) (cf. 1, 2)
Université d'Eté pour Enseignants(UEE)	and

Français Semi Intensif (FSI)	and

Cours Particuliers (CP)
Total and per week: from (DD/MM/YY) to (DD/MM/YY)
1) No beginners (A0) in these courses 2) Confirmation subject to level after doing the evaluation test (to be sent with your enrolment form by post or fax: +33 (0)4 42 26 31 80)

Combination of courses and possible dates on request: contact us

Accommodation choice


from Date (DD/MM/YY) to Date (DD/MM/YY)

Do you have any allergies?	Yes No - if yes, specify:
Do you smoke?	Yes No
Do you have an illness or handicap that we should know about?	Yes No - If yes, specify:
Other useful information to fulfill your wishes, please indicate your maximum accomodation budget for the chosen period? Will you have a car or motorbike during your stay? If yes, would you agree to live in the areas surrounding Aix? Would you agree to be in a family with moderate smokers?

Transfers

Please book me a taxi

Arrival Date (DD/MM/YY) Time (hh:mm) Place :
Details (flight n°, train, bus):

Departure Date (DD/MM/YY) Time (hh:mm) Place :
Details (flight n°, train, bus):

Your mobile telephone number to contact you if there is a problem

Supplementary information

Person to contact in case of accident or illness (name, email, tel, fax)

Are you insured for your stay in France?*	Yes No
Name and number of your insurance policy
(1) We recommend our students to take out insurance which covers civil liability, illness, accidents, loss of valuables or baggage, theft and cancellation or interruption of the course for personal or health reasons.

Step 3/3: Payment

To reserve a place, please send a deposit:
enrolment fee 65 euros + 70 euros per week of course

Mode of payment

by Credit Card (secure online payment)

by bank transfer (bank fees are payable by you)

by banker's cheque in euros (endorsable in France) payable to IS Aix-en-Provence

Comments

Yes, I accept the general conditions

All information that is given to us by you is treated strictly confidential and is not communicated in any way without your written consent.

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Tél : + 33 (0)4 42 93 47 90 - Fax : + 33 (0)4 42 26 31 80

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