4, Impasse Romagnoli 84000 AVIGNON
Tél / Fax +33 (0)4 90 85 86 24
Email : alfa@alfavignon.com
Internet : www.alfavignon.com

REGISTRATION FORM
A To be completed and returned to : A.L.F.A. 4, Impasse Romagnoli 84000 Avignon - France.
available by fax

SURNAME
First name
Date of Birth
Age :
Nationality
Address
Post code
Ville :
Tel :
Fax :
e-mail
How did you come to know about ALFA?
Nombre d’années d’études en Français :
Knowledge of written
none - insufficient - reasonable - good
French language oral
none - insufficient - reasonable - good
Application for the following course :

du : au : nombre de semaines :

Choice of accommodation (1) :

Other

Chez l'habitant - Hôtel- Studio

Pay now, the sum of 154 €.¹ As a reservation fee (deductible from the total cost of the course)

By cheque International money order Direct banking Euro cheque

For ALFA : Account number 055 15013524 Banque Populaire - Place Pie 84000 Avignon – France -

Declare having understood the General Conditions of the school and agree to abide by them
• Return
• Home contact
Fait à : le :

Signature : 

Important: Fees paid by cheque or direct banking must be increased by 10 % for the bank fees

(1) Tick the box corresponding to your choice