First Name:



Last name :



Date of birth :



Nationality :



Street address :



City :



State :



Zipcode :



Home phone number :



Cell phone number :



E-mail address:



Do you have any medical condition that the school should be aware of?



Previous experience in French :



Estimated level in French (you may be contacted by one of our representative in order to assess your level with accuracy) :



What is your primary goal for this course ? (personal growth, professional…)



I have read and agree with the Terms and Conditions :