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 :