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 would like to make a firm reservation for a foreign language course:

Language*:

Type of Course*:
	• In order to book individual tuition (one-to-one lessons), please click here!

Level*:

Start Date*:

Duration*:

My knowledge of this language:
Self Evaluation*:
I have learnt this before
- for how long?

Comments:

Personal Data:

Title:	Ms Mr
First Name*:
Surname*:
Birth date*:	(Day, Month, Year)
Native Language*:

Country*:
Post Code*:
Town*:
Street*:

Telephone:
E-Mail*:

	I have read and accepted the •Terms & Conditions

Agreement:
The registration cost is: 12,50 €
My place on the course will be resevered as soon as my payment of 50 € has been recieved by IH Berlin PROLOG (•Our Bank Details).

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

+49 30 7811076 • • City Map & Route Planner

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