Intensive French Immersion Course Registration Form 2010

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 2009 - 2010

	2 Week Courses	Price	Deposit	Balance
Premier (French+Culture/Recreation) 14 DAYS	3 January – 17 January 2010	CHF 4,900	CHF 1,470	CHF 3,430
	10 January – 24 January 2010	CHF 4,900	CHF 1,470	CHF 3,430
	17 January – 31 January 2010	CHF 4,900	CHF 1,470	CHF 3,430
	31 January – 14 February 2010	CHF 5,400	CHF 1,620	CHF 3,780
	14 February – 28 February 2010	CHF 5,400	CHF 1,620	CHF 3,780
	28 February - 14 March 2010	CHF 4,900	CHF 1,470	CHF 3,430
	7 March - 21 March 2010	CHF 4,900	CHF 1,470	CHF 3,430
	14 March - 28 March 2010	CHF 4,900	CHF 1,470	CHF 3,430
	28 March - 11 April 2010	CHF 4,900	CHF 1,470	CHF 3,430
	25 April - 9 May 2010	CHF 4,900	CHF 1,470	CHF 3,430
	13 June - 27 June 2010	CHF 4,900	CHF 1,470	CHF 3,430
	27 June - 11 July 2010	CHF 4,900	CHF 1,470	CHF 3,430
	11 July - 25 July 2010	CHF 4,900	CHF 1,470	CHF 3,430


	25 July - 8 August 2010	CHF 5,150	CHF 1,545	CHF 3,605
	8 August - 22 August 2010	CHF 4,900	CHF 1,470	CHF 3,430
	15 August - 29 August 2010	CHF 4,900	CHF 1,470	CHF 3,430
	5 September – 19 September 2010	CHF 4,900	CHF 1,470	CHF 3,430
	26 September – 10 October 2010	CHF 4,900	CHF 1,470	CHF 3,430
	5 December – 19 December 2010	CHF 4,900	CHF 1,470	CHF 3,430
	None
French+Golf 14 DAYS	13 June - 27 June 2010	CHF 6,400	CHF 1,920	CHF 4,480
	27 June - 11 July 2010	CHF 6,400	CHF 1,920	CHF 4,480
	11 July - 25 July 2010	CHF 6,400	CHF 1,920	CHF 4,480
	25 July - 8 August 2010	CHF 6,650	CHF 1,995	CHF 4,655
	8 August - 22 August 2010	CHF 6,400	CHF 1,920	CHF 4,480
	15 August – 29 August 2010	CHF 6,400	CHF 1,920	CHF 4,480
	15 August – 29 August 2010	CHF 6,400	CHF 1,920	CHF 4,480
	5 September – 19 September 2010	CHF 6,400	CHF 1,920	CHF 4,480
	12 September – 26 September 2010	CHF 6,400	CHF 1,920	CHF 4,480
	26 September – 10 October 2010	CHF 6,400	CHF 1,920	CHF 4,480
	None
French+Skiing 14 DAYS	3 January - 17 January 2010	CHF 5,500	CHF 1,650	CHF 3,850
	10 January - 24 January 2010	CHF 5,500	CHF 1,650	CHF 3,850
	17 January – 31 January 2010	CHF 5,500	CHF 1,650	CHF 3,850
	31 January – 14 February 2010	CHF 6,000	CHF 1,800	CHF 4,200
	14 February – 28 February 2010	CHF 6,000	CHF 1,800	CHF 4,200
	28 February - 14 March 2010	CHF 5,500	CHF 1,650	CHF 3,850
	7 March - 21 March 2010	CHF 5,500	CHF 1,650	CHF 3,850
	14 March – 28 March 2010	CHF 5,500	CHF 1,650	CHF 3,850
	None
French+Hiking 14 DAYS	13 June - 27 June 2010	CHF 4,900	CHF 1,470	CHF 3,430
	27 June - 11 July 2010	CHF 4,900	CHF 1,470	CHF 3,430
	11 July - 25 July 2010	CHF 4,900	CHF 1,470	CHF 3,430
	25 July - 8 August 2010	CHF 5,150	CHF 1,545	CHF 3,605
	8 August - 22 August 2010	CHF 4,900	CHF 1,470	CHF 3,430
	15 August - 29 August 2010	CHF 4,900	CHF 1,470	CHF 3,430
	5 September - 19 September 2010	CHF 4,900	CHF 1,470	CHF 3,430
	12 September - 26 September 2010	CHF 4,900	CHF 1,470	CHF 3,430
	26 September – 10 October 2010	CHF 4,900	CHF 1,470	CHF 3,430
	None
	4 Week Courses	Price	Deposit	Balance
Premier (French+Culture/Recreation) 28 DAYS
	28 March - 9 May 2010	CHF 9,800	CHF 2,940	CHF 6,860
	13 June – 11 July 2010	CHF 9,800	CHF 2,940	CHF 6,860
	5 September - 10 October 2010	CHF 9,800	CHF 2,940	CHF 6,860
	None
French+Skiing 28 DAYS	3 January -31 January 2010	CHF 11,000	CHF 3,300	CHF 7,700
	28 February - 28 March 2010	CHF 11,000	CHF 3,300	CHF 7,700
	None
French+Golf 28 DAYS	13 June - 11 July 2010	CHF 12,800	CHF 3,840	CHF 8,960
	5 September - 10 October 2009	CHF 12,800	CHF 3,840	CHF 8,960
	None
Short Courses	Specials	Price	Deposit	Balance
6-day Easter Special	1 April - 6 April 2010	CHF 2,100	CHF 630	CHF 1,470
7-day French+Hiking/Culture	27 June - 4 July 2010	CHF 2,450	CHF 735	CHF 1,715
7-day French+Culture	27 June - 4 July 2010	CHF 2,450	CHF 735	CHF 1,715
7-day French+Golf	27 June - 4 July 2010	CHF 2,450	CHF 735	CHF 1,715
7-day French+Skiing	3 January - 10 January 2010	CHF 2,750	CHF 825	CHF 1,925
	None
* Please Note : No classes 19th March, 2010 (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.