Registration Form 2016Family Name *First Name *GenderFemaleMaleDate of Birth * NationalityCountry of BirthPassport NumberPassport Expiry Date Street*Area code*Town*Country*State*Email address *Home phone*Mobile phone*OccupationPerson to contact in case of emergency : Spouse / Parent /etc Family Name First Name Street*Area code*Town*Country*State*Email Address Home phoneMobile phoneIs there any important information that you wish to communicate ? Do you have special dietary requirements? Are you receiving any medical treatments that we should know about ? Are you allergic to any type of food ? Are you allergic to animals (we have a small dog and two cats) ? If yes please specify : Do you have any allergies ? Please give details :Native language Other languagesFRENCH KNOWLEDGEHave you studied French ? neveron my own at school traveling For how long ? Are you taking French classes in your country ? yesnoIf yes : Since when ?What is your level in French? A1 : Beginner / ElementaryB1 : IntermediateC1 : AdvancedA2 : Elementary advancedB2 : Intermediate advancedC2 : Perfection / improvementHave you ever visited France ?yesnoWhen ?For how long ? Please list your main interests and hobbies :What would you like to learn with NéfliLang ?Arrival date preferred* Departure date* CourseIndividual course « one on one » Private room + bathroom 2 course people Private room + bathroom per person2 course people Double room + bathroom Number of weeks : 123(The duration of your course is up to you : one, two or three weeks. The training courses are very intensive, they cannot exceed three weeks) I have read and I agree to the General Terms and Conditions.*YesNoOnce we have received your registration form, we will e-mail or send by post a confirmation Order Form with our bank details. Please return a copy of this order to us, signed for approval and confirmation of your deposit by bank transfer (350 € for a week course or 600 € for an course of two or three weeks). YOUR REGISTRATION IS VALID AS SOON AS WE RECEIVE THE DEPOSIT AND SIGNED COPY OF THE ORDER FORM. The balance must be paid one month before the course begins (If you sign up one month before the course, the entire course must be paid for upon receipt of confirmation).