Learn French France | learning French France | learn to speak French in France with Alfmed Perpignan

Reservation

> Please complete the Reservation form below (the fields marked with * must be completed) then click "Submit" to book your stay

Last Name :		*
First Name :		*
Date of Birth :		(dd/mm/yyyy)*
Gender :		M F

Address :		*

Zip code :		*
City :		*
Country :		*

Telephone 1 :
Telephone 2 :
E.mail :		*

Level of french :		*
(see "French Levels" on alfmed.com for more details)

Choice of Program :		*
(see "Various Programs" on alfmed.com for more details)

Choice of stay :		*

Starting Month :		* Year : *

You will come :*		Alone with a group of people

Choice of Lodging :		*
(see "accomodations" on alfmed.com for more details)

Please indicate any information you may consider important for your lodging

To book your stay at the Academy, you must pay the Registration Fee of 150 euros (non-refundable) which includes the Administrative formalities. This amount will be deducted from the total price of your stay.

Method of Payment :* proceed to payment for the Registration Fee of 150 euros to reserve your stay

Bank transfer to ALFMED
21 bis Ave du Général de Gaulle - 66000 PERPIGNAN - France

Bank : Banque Courtois Perpignan
1 Place Bardou Job - BP 346 - Perpignan Cedex - 66003 France
Tel : +33 468 257 272 – Fax: +33 468 357 299

Bank Transfer :		IBAN : FR76 1026 8025 2043 1685 0020 053 SWIFT CODE : COURFR2TXXX

Credit Card :		If you choose this method, Alfmed will contact you by phone for the transaction (please indicate a valid telephone number on the "Personal Détails" part of this form)

You will receive by email the receipt of your payment and confirmation of conditions The balance of fees must be paid 2 weeks before arrival. The Registation Fee is non-refundable. Please see registration conditions and cancellation policy on the website : "Various programs and agreements"

Once the final receipt will be issued, you will have to fill-in your arrival details. So we will take care of your welcome !

If you need to make any additional commentary

I accept the conditions of Registration
at Académie de Langues France MEDitérranée

According to the 01/16/1978 law, you can have access and modify personal information. ALFMED respects the privacy of the users of this website. You may change or delete your details at any time, contact us.