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UNIPORT FRENCH LANGUAGE PROGRAMMES -- FICHE D’INSCRIPTION / REGISTRATION FORM
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* Indicates required question
Title
*
Ms
Mr.
Nom / Surname
*
Your answer
Prénom / First name
*
Your answer
Date de naissance / Date of birth
*
MM
/
DD
/
YYYY
Lieu de naissance / Place of birth
Your answer
Profession
*
Your answer
Adresse / Address
*
Your answer
N° de téléphone / Phone number
*
Your answer
Courriel / Email address
*
Your answer
Je m’inscris à la session / I sign up for the session
*
Choose
Morning Intensive Class (60 hrs over 4 wks)
Afternoon Semi-intensive (52.5 hrs over 7 wks)
Conversation class (10 hrs over 4 week)
ONLINE evening class (50 hrs over 4 wks)
Starting on (type the date)
*
MM
/
DD
/
YYYY
J’ai connu l’Alliance Française par/ I got to know about Alliance Française by
*
Radio advert
Friends / Word of mouth
Browsing on internet
Saw a banner or sign
Other:
Required
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