Booking a German course

Thank you for your interest in IH Berlin PROLOG's language course. Please complete this form as precisely as possible so that we can authorise your order.

I would like to book the following German course:
Course type:

Course length:	Weeks
Time frame:	to

My knowledge of German:
Self assessment:
	If you have taken our •Online Test, which test levels did you reach at least 80%?
	A1 A2 B1 B2

I have already studied German:
-Course length:

Your accommodation in Berlin?
Preferred accommodation:
*Double or twin room, sharing with:
Do you smoke?	Yes No

If the accommodation I have selected is not available, I would like:


How are you travelling to Berlin?
Date:
Transfer:
Which airport or train station will you be arriving at?
Flight/Train number:	at o'clock

Do you need a visa?
	Yes No
Passport number:
How do you want the documents sent:

Comments:	E.g. allergies, dietary requirements, special requests

Personal Details:
Title:	Ms. Mr.
First name:
Surname:
Date of Birth:	(Day, Month, Year)
Native language:
Country:
Zip/Post Code:
City:
Street:
Phone:
e-mail:
	I have read and accept the • Terms & conditions.

Remarks:
Registration fee: € 60
Between 04.07.2010 and 28.08.2010 the prices for all courses and accommodation are 10% higher.
A place on a course will be reserved for me as soon as my advance payment of € 150 reaches IH Berlin PROLOG. (Bank details)

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International House Berlin PROLOG • D-10827 Berlin • Hauptstraße 23/24

+49 30 7811076 • • City Map & Route Planner

International House Berlin PROLOG

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