Intensive French Immersion Course Registration Form 2011

PERSONAL DETAILS
Mr Mrs Ms Dr Surname	Gender		Medical conditions
First Name	Date of birth		Medical conditions
Country of Birth	Nationality	Profession/Occupation	Dietary requirements:
Arriving in Crans-Montana by: Car Bus Funicular Unknown	Estimated arrival time:

CONTACT DETAILS
Address	City/Suburb	State/Province
Country	Postcode	Mobile (incl country & area code)
E-mail	Tel (incl. country & area code)	Fax (incl. country & area code)
EMERGENCY CONTACT DETAILS
Mr Mrs Ms Dr Name	Tel (incl. country & area code)	Mobile (incl. country & area code)
Address	City/Suburb	Country
Postcode

LANGUAGE EXPERIENCE

If you have some knowledge of French, please indicate your level according to the “Common European Framework of Reference for Languages”:

Estimated Level:

Absolute beginner
A1
A2
B 1
B 2
C 1
C 2

Mother tongue

Other languages

LEVEL OF SKIING

SKI:

Absolute beginner
Beginner
Intermediate
Advanced

LEVEL OF GOLF

GOLF:

Absolute beginner
Beginner
Intermediate
Advanced

Handicap

*ENROLMENT It is possible to combine these courses, eg. 2-week Premier + 2-week French+Golf**
COURSES, DATES AND PRICES FOR 2011

	2 Week Courses	Price	Deposit	Balance
Premier (French+Culture/Recreation) 14 DAYS	2 January – 16 January 2011	CHF 4,900	CHF 1,470	CHF 3,430
	9 January – 23 January 2011	CHF 4,900	CHF 1,470	CHF 3,430
	16 January – 30 January 2011	CHF 4,900	CHF 1,470	CHF 3,430
	30 January – 13 February 2011	CHF 5,400	CHF 1,620	CHF 3,780
	13 February – 27 February 2011	CHF 5,400	CHF 1,620	CHF 3,780
	27 February - 13 March 2011	CHF 4,900	CHF 1,470	CHF 3,430
	6 March - 20 March 2011*	CHF 4,900	CHF 1,470	CHF 3,430
	13 March - 27 March 2011*	CHF 4,900	CHF 1,470	CHF 3,430
	20 March - 3 April 2011	CHF 4,900	CHF 1,470	CHF 3,430
	27 March - 10 April 2011	CHF 4,900	CHF 1,470	CHF 3,430
	3 April - 17 April 2011	CHF 4,900	CHF 1,470	CHF 3,430
	12 June - 26 June 2011	CHF 4,900	CHF 1,470	CHF 3,430
	26 June - 10 July 2011	CHF 4,900	CHF 1,470	CHF 3,430
	10 July - 24 July 2011	CHF 4,900	CHF 1,470	CHF 3,430


	24 July - 7 August 2011	CHF 5,150	CHF 1,545	CHF 3,605
	7 August - 21 August 2011	CHF 4,900	CHF 1,470	CHF 3,430
	14 August - 28 August 2011	CHF 4,900	CHF 1,470	CHF 3,430
	4 September – 18 September 2011	CHF 4,900	CHF 1,470	CHF 3,430
	25 September – 9 October 2011	CHF 4,900	CHF 1,470	CHF 3,430
	9 October – 23 October 2011	CHF 4,900	CHF 1,470	CHF 3,430
	23 October – 6 November 2011	CHF 4,900	CHF 1,470	CHF 3,430
	4 December – 18 December 2011	CHF 4,900	CHF 1,470	CHF 3,430
	None
French+Golf 14 DAYS	12 June - 26 June 2011	CHF 6,600	CHF 1,980	CHF 4,620
	26 June - 10 July 2011	CHF 6,600	CHF 1,980	CHF 4,620
	10 July - 24 July 2011	CHF 6,600	CHF 1,980	CHF 4,620
	24 July - 7 August 2011	CHF 6,850	CHF 2,055	CHF 4,795
	7 August - 21 August 2011	CHF 6,600	CHF 1,980	CHF 4,620
	14 August – 28 August 2011	CHF 6,600	CHF 1,980	CHF 4,620
	14 August – 28 August 2011	CHF 6,600	CHF 1,980	CHF 4,620
	4 September – 18 September 2011	CHF 6,600	CHF 1,980	CHF 4,620
	11 September – 25 September 2011	CHF 6,600	CHF 1,980	CHF 4,620
	25 September – 9 October 2011	CHF 6,600	CHF 1,980	CHF 4,620
	None
French+Skiing 14 DAYS	2 January - 16 January 2011	CHF 5,700	CHF 1,710	CHF 3,990
	9 January - 23 January 2011	CHF 5,700	CHF 1,710	CHF 3,990
	16 January - 30 January 2011	CHF 5,700	CHF 1,710	CHF 3,990
	30 January – 13 February 2011	CHF 6,200	CHF 1,860	CHF 4,340
	13 February – 27 February 2011	CHF 6,200	CHF 1,860	CHF 4,340
	27 February - 13 March 2011	CHF 5,700	CHF 1,710	CHF 3,990
	6 March - 20 March 2011	CHF 5,700	CHF 1,710	CHF 3,990
	13 March – 27 March 2011	CHF 5,700	CHF 1,710	CHF 3,990
	None
French+Hiking 14 DAYS	12 June - 26 June 2011	CHF 4,900	CHF 1,470	CHF 3,430
	26 June - 10 July 2011	CHF 4,900	CHF 1,470	CHF 3,430
	10 July - 24 July 2011	CHF 4,900	CHF 1,470	CHF 3,430
	24 July - 7 August 2011	CHF 5,150	CHF 1,545	CHF 3,605
	7 August - 21 August 2011	CHF 4,900	CHF 1,470	CHF 3,430
	14 August - 28 August 2011	CHF 4,900	CHF 1,470	CHF 3,430
	4 September - 18 September 2011	CHF 4,900	CHF 1,470	CHF 3,430
	11 September - 25 September 2011	CHF 4,900	CHF 1,470	CHF 3,430
	25 September – 9 October 2011	CHF 4,900	CHF 1,470	CHF 3,430
	None
	4 Week Courses	Price	Deposit	Balance
French+Culture 28 DAYS
	27 March - 8 May 2011	CHF 9,800	CHF 2,940	CHF 6,860
	12 June – 10 July 2011	CHF 9,800	CHF 2,940	CHF 6,860
	4 September - 9 October 2011	CHF 9,800	CHF 2,940	CHF 6,860
	None
French+Skiing 28 DAYS	2 January - 30 January 2011	CHF 11,400	CHF 3,420	CHF 7,980
	27 February - 27 March 2011	CHF 11,400	CHF 3,420	CHF 7,980
	None
French+Golf 28 DAYS	12 June - 10 July 2011	CHF 13,200	CHF 3,960	CHF 9,240
	4 September - 9 October 2011	CHF 13,200	CHF 3,960	CHF 9,240
	None
Short Courses	Specials	Price	Deposit	Balance
6-night Easter Special	21 April - 27 April 2011	CHF 2,100	CHF 630	CHF 1,470
French+Culture/Recreation	26 June - 3 July 2011	CHF 2,450	CHF 735	CHF 1,715
French+Golf	26 June - 3 July 2011	CHF 3,300	CHF 990	CHF 2,310
French+Skiing	26 June - 3 July 2011	CHF 2,850	CHF 855	CHF 1,995
French+Hiking	21 August - 28 August 2011	CHF 2,450	CHF 735	CHF 1,715
	None
* 19th March - Public Holiday

PAYMENTS* All payments are to be made in Swiss francs (CHF)
	Deposit on registration - 30%	Balance of payment 30 days prior to commencement
TOTAL COST	DEPOSIT	BALANCE

Group discounts are applicable to a minimum of six clients enrolled in the same course and level. Please Enquire.

Payment -
By IBAN/BIC — Electronic Bank Transfer to:

Account Name:	Académie de français Crans-Montana Sàrl
Account No:	0182-983948-91-1
IBAN:	CH 96 0483 5098 3948 9100 1
BIC SWIFT Code:	CRESCHZZ12A
Bank:	Credit Suisse 8070 Zurich Switzerland
Branch:	Crans–Montana, CH-3963

*If payment is made by bank transfer, all bank fees and charges are the responsibility of the participant.

I have read and understood, and I agree to be bound by, the Terms and Conditions.

By Submitting the registration Form, I acknowledge that I have read and understood, and that I agree to be bound by, the Terms and Conditions
Alternatively, you may wish to post or fax this Registration Form. Please click for printable format.