Enrolment Form
Surname
First Name(s)
Gender
---
Male
Female
Other
Prefer not to say
Address
Postal Code
Town
Country
Tel Nº
E-Mail
Date of Birth
Nationality
Occupation
Smoker
Yes
No
Allergies / Special dietary needs:
Yes
No
Details
Level of Portuguese
Beginner
Elementary
Intermediate
Advanced
Have you studied Portuguese before? (Where/when/how long?)
Do you have any specific reason for learning Portuguese?
Preferences (Optional Question): What do you do for fun?
I wish to be enrolled for the following program
---
INDIVIDUAL LESSONS (or private group)
GROUP LESSONS
COMBI-MIX LESSONS (group lessons in the morning + private lessons in the afternoon)
E-LEARNING (SELF STUDY PROGRAMMES)
Select an option
Duration
hours
days
weeks
months
Start Date
Nº People:
1
2
3
4
5
6
7
8
People’s names:
I would like host family accommodation arranged for me
Yes
No
I would like a Pick Up / Transfer service organized for me
Yes
No
Additional Comments
I agree with the
terms and conditions
Submit
