Mrs Miss Mr
(All fields marked with a star* must be filled out).
NAME*
First Name*
Nationality*
Date of birth* (MM/JJ/AAAA)
Address*
Country*
e-mail adress*
Tel*
Profession /Study*
How did you hear of alpha-b ?
You would like to improve your French skills in order to :
OFFERED COURSES* :
N°1 - Continuous French N° 2 - Intensive French N°3a - Combination 20+5 (1) N°3b - Combination 20+10 (1) N°4 - Individual Course (1et 2) N°5 - DELF (3) N°6 - Executive French N°7 - French for Teachers N°8 - A Level N°9 - French + Cooking N°10 - French + Arts N°11 - Course Club 50
(1) – For a Combination Course: Please state topic fort the individual lessons (2) – For an Individual Course: Please state topic and number of lessons per day (3) – For a DELF Course: Don’t forget to state which diploma you wish to take: A1-A2-B1 or B2.
I would like to enrol in the following course programme :
My knowledge in French* : On your first day in Nice you will do a written and oral placement test. Nevertheless, we kindly ask you to do our Quick Test. Please circle the result below.
A0 Beginner A1 Breakthrough A2 Waystage B1 Threshold B2 Vantage C1 Effective Proficiency C2 Mastery
Remark
SPORTS OPTIONS :
Sailing Diving
ACCOMMODATION : Do you smoke ? Yes No
University Residence : Room for 1 person
With a French host : single room double room
With a family : single room double room
In a bed-sit : 1 person 2 persons
Student Hotel Residence CITEA** : 1 person 2 persons
2 persons (big French bed) 2 persons (2 single beds)
Apartment Hotel Lamartine **** : 18 m2 30 m2 45 m2 60 m2
In a hotel : single room double room
Nouvel Hotel Villa Victoria Mercure Hotel
Date of arrival (JJ/MM/AAAA)
Date of departure (JJ/MM/AAAA)
Remarks or wishes concerning your course or accommodation (allergies, diets, …) :
I confirm that I wish to book accommodation and have sent a deposit of 25% of the total accomodation price by bank transfer or credit card payment on this site (secure data connection). This deposit will be deducted from the total amount of my invoice. IMPORTANT : => In case of online payment by credit card, make sure that you have valid your booking first. For this click the bottom "envoyer" and from then you will be guided. => In case of a bank transfer, you are requested to send us a copy of the transfer order by post, fax or e-mail. Don't forget to state your name clearly so that we can proceed with your booking. *For under age students this application form has to be signed by the parents or a legal tutor. It has to been sent along with a permission form which can be downloaded on our website www.alpha-b.fr.
Your invoice has to paid at the latest on the first day of the class. You may pay by credit card, cheque, bank transfer or cash. Bank Transfer : CREDIT AGRICOLE - 47 Bd de Cimiez 06000 NICE - France IBAN : FR 76 1910 6006 8000 9631 2601 895 BIC / SWIFT : AGRIFRPP891 Account Owner : ALPHA-B / Account N° : 00963126018 / Code Bank : 19106 / Code position : 00680 / Key R.I.B : 95