Enrolment Form
Surname
First Name(s)
Gender
Male
Female
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
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
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
