I enrol for the course(s):

Term no. to (including) no. at the "zentrum für deutsche sprache und kultur" language school

Type:
Compact Plus	Combined 40 class

My level of German:
Elementary level A1	Level A2	Level B1
Intermediate level B2	Intermediate level C1	Advanced level C2

Where did you previously learn German?

How long did you study German? What book(s) have been used?

I need a special certificate to apply for visa:

yes

no

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Gender:	female	male
Family name:			First name:
Address:	street/no.
	postal code city
	country
Telephone:			Fax:
E-mail:			Date of birth:
Profession:			Nationality:

I have read and I accept the terms of enrolment.
Place/Date (Signature)

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I need accommodation:

yes

no

half-board		I need transfer
I'm a smoker		I'm allergic to pets

Additional personal requests:

I have read and I accept the terms of accommodation, including the paragraph referring to the deposit.
Place/Date (Signature)