Adults and students

By sending the form below you definitely are enrolling on a language course. We will be happy to help you with any additional information.

Personal details

* Title

* Surname

* First name

* Date of birth

* Nationality

* Place of birth

* Mother tongue

* Language level

Profession

* Address

* Postcode

* City/town

* Country

* Private tel.

Work tel.

Mobile

Fax

* E-mail address

If student, school attended

Contact person during your stay

* Surname

* First name

* Private tel.

Selection of course(s)

* 1) Town/city

* Name of the school

* Course type

* Start date

* End date

* Number of weeks

2) Town/city (to be filled in only if 2 destinations)

Name of the school

Course type

Start date

End date

Number of weeks

Miscellaneous

I am a vegetarian

yes no

I am a smoker

yes no

Special diet

Allergies/Medical treatment

Leisure, interests

Other wishes

Flight / airport transfer

* I wish to receive an offer for the flight

yes, from no

* I wish to have an airport transfer

arrival departure both no

Insurances

* I wish to receive a cancellation-assistance insurance - 3 months (EUR 55.-)

yes no

* Extension of the assistance insurance: (EUR 6.30 per month)

yes. Number of months no

* I wish to have free exam cancellation protection (please send us proof of enrolment for an exam)

yes no

Confirmation & sending

* I completely agree with the general terms and conditons of ESL.

* How did you find out about ESL?

Please specify

Promotional code

* Compulsory fields

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