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Private Lessons
Please complete the form below. The items marked
*
are mandatory.
[1] PERSONAL INFORMATION:
Title
*
Select a title
Ms.
Mr.
Mrs.
First Name
*
Last Name
*
Birth Date
(Mandatory for Kids only)
(mm/dd/yyyy)
Age Range
(Adults)
Select
18-29
30-44
45-59
60+
Home phone
*
Cell phone
Work Situation
Select
Student
Full-time Job
Part-time / Freelance
Retired
At Home
Office phone
Company Name
(If responsible for payment)
E-Mail
*
Fax
Address
*
Street:
Apt.#
City:
State:
Zip:
[2] LESSON REQUIREMENTS:
Have you taken a class with us before?
Yes
No
Location of Class:
At Our Location
Yes
At Your Location:
(Please specify address, intersection and subway)
Number of Hours per week:
Frequency of Classes:
Starting Date:
Availability (days & times):
Level of French:
(101, 102 ... )
(If not a Beginner Level Student, please take the
Placement Test
first)
Reason for studying French:
Select
Travel
Business
Pleasure
Studies/School
Relocating to French speaking country
Where did you hear about us?
New York Times
Time Out NY
FIAF Events Calendar
FIAF Language Center Brochure
Word of Mouth
Web Search
[3] TRAINING OBJECTIVES:
[4] COMMENTS:
Feel free to use the box below if you have any comment /suggestion regarding your registration on this form.
©2008 French Institute Alliance Française, 22 East 60th Street, NYC | 212 355 6100