Booking for a course in a language other than German

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

I want to make a binding booking for the following language course:

Language*:

Course type*:	Exclusive-course (individual lessons) Duo-course (2 participants)
	• In order to book group tuition, please click here!

Course length*:

In which time frame would you like to have your language course?
Start*:
End*:
(We will need 3-5 days after your registration to arrange a suitable teacher and schedule within the school)

My knowledge of the language:
Self assessment*:
I have already learned the language:
- how long?

Comments:

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.

Notes:
The booking fee is: 12,50 €
My course will be reserved as soon as my deposit of € 50 has been received by PROLOG. (•Bank details)

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ESL PROLOG - Berlin • D-10827 Berlin • Hauptstraße 23/24

+49 30 7811076 • • City Map & Route Planner

ESL PROLOG - Berlin

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