Booking for a course in a language other than German

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 want to make a binding booking for the following course:

Language*:

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

Course length*:

On which days would you like to have your language course?
	Monday Tuesday Wednesday Thursday Friday

Time frame?
Start*:
End*:

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 PROLOG's • General 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)