|
|
 Enrolment form 2009 / 2010
|
|
|
|
Title*
|
|
|
First name*
|
|
|
Surname*
|
|
|
Address*
|
|
|
Postcode*
|
|
|
City*
|
|
|
Date of birth
(dd-mm-yy)*
|
|
|
Place of birth*
|
|
Country of birth* |
|
|
Native language*
|
|
|
Telephone work
|
|
|
Telephone home*
|
|
|
Mobile phone*
|
|
|
Name of company
|
|
|
E-mail address*
|
|
|
Send invoice
to
|
|
|
|
|
|
Wishes to enrol
for
|
|
Group of max. 8 students, 36 hrs, 12 wks (2 x1 ½ hrs per week)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Group of max. 8 students, 30 hrs, 2 weeks ( 3 hrs per day)
|
|
Date and time:
|
|
|
|
|
Group of max. 8 students, 19 hrs, 12 wks (1 x 1 ½ per week) + 1 hr intro
|
|
Month:
|
|
|
|
|
|
|
|
Group of max. 8 students, 24 hrs, 6 wks (Tuesday and Friday)
|
|
Month:
|
|
|
|
|
Group of max. 10 students, 25 hrs, 1 x 2 hrs per week) + 1 hr intro
|
|
Month:
|
|
|
|
|
|
|
|
|
|
|
|
Remarks
|
|
|
|
|
How did you get in touch with Direct Dutch?
|
|
|
|
|
|
|
I agree with the general conditions*
|
|
|
|
|
|
|
|
|
