Give your VAT or registration number if you have one, ignore otherwise.

Company name		VAT/company n°
Street and number		Post code
Town		Country	Select Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Herzegovina Botswana Bouvet Island Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati South Korea North Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn (Island) Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Lucia Samoa San Marino Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe
Office phone		Fax
Department		Company website
Send the company invoice for my attention		to another contact person

First name*		Surname*
Job title*		Phone
E-mail

ENGLISH GROUP LESSONS
 
Choose your programme :

	General course – Thursday or Wednesday from 6 to 9 pm
	Option:	full year from September until June first semester from September until January second semester from February until June
	General course : – Saturdays from 10 am to 1 pm
	Option:	full year from September until June first semester from September until January second semester from February until June
	English exam preparation course - Wednesday from 6 to 9 pm
	Option:	full year from September until June first semester from September until January second semester from February until June
	English exam preparation course - Saturdays from 10 am to 1 pm
	Option:	full year from September until June first semester from September until January second semester from February until June
	Conversation table - Tuesday from 6 pm to 8 pm
	Option:	12 sessions 24 sessions
	Junior club: for teenagers
	Option:	Wednesdays from 2 to 4 pm Mondays from 4:30 to 6:30 pm
	Summer intensives in July and/or August - daily from 9 am to 1 pm
	Option:	1 week 2 weken 3 weken 4 weken 5 weken
	Requested starting date
	I’m not sure yet

Additional information or questions:

To close this information sheet, please make your choice:

	I want to register for this course.
	I will contact the school for more information before I decide.

INDIVIDUAL LESSONS
 
Private tuition is the most flexible formula, allowing a more personalized approach.
The following needs analysis will allow us to better adapt the lessons to meet your personal objectives.

Explain your needs.
 
1. Which skills would you like to improve most?
 

Principal objective:	grammar speaking listening reading writing vocabulary
Second objective:	grammar speaking listening reading writing vocabulary
Third objective:	grammar speaking listening reading writing vocabulary

2. In which situations do you intend to use the language?

Most important situation:	general cultural interests or hobbies tourism, visits abroad or social life exam preparation professional situations (meetings, socialising, telephone) public speaking (giving presentations, training, sales) professional writing (email, standard letters) advanced professional writing (reports, presentations) other (please specify below)
Second most important situation:	general cultural interests or hobbies tourism, visits abroad or social life exam preparation professional situations (meetings, socialising, telephone) public speaking (giving presentations, training, sales) professional writing (email, standard letters) advanced professional writing (reports, presentations) other (please specify below)
Third most important situation:	general cultural interests or hobbies tourism, visits abroad or social life exam preparation professional situations (meetings, socialising, telephone) public speaking (giving presentations, training, sales) professional writing (email, standard letters) advanced professional writing (reports, presentations) other (please specify below)

3. Specify your goals:

Timetable

Where would you like to have your lessons?	at the school at your company at your home by phone or Skype elsewhere
If not at the school, please indicate the address:
Please give us some margin of hours or choice of day(s).
Earliest starting time:	8.00 8.30 9.00 9.30 10.00 10.30 11.00 11.30 12.00 12.30 13.00 13.30 14.00 14.30 15.00 15.30 16.00 16.30 17.00 17.30 18.00 18.30 19.00 19.30 20.00 20.30 21.00
Latest finishing time:	10.00 10.30 11.00 11.30 12.00 12.30 13.00 13.30 14.00 14.30 15.00 15.30 16.00 16.30 17.00 17.30 18.00 18.30 19.00 19.30 20.00 20.30 21.00 21.30 22.00
Lesson duration:
(Average) number of lessons per week:	1 2 3 4 5
Day(s) of the week you are available:	maandag dinsdag woensdag donderdag vrijdag zaterdag
Preferred starting date:

Which individual course are you interested in:

The course material is included in the price – VAT exempt

	Private lessons	30 hours 60 hours
	Intensive lessons - 7 hours/day	one week two weeks
	Intensive lessons - 4 hours/day	one week two weeks
	Distance learning	4 months 8 months
	Business skills	individual (specify skill below) company group (specify skill below)
	don’t know yet / other request: specify below

Additional comments
 

Thank you for your time.
Please send this information form. It will be very useful to help us in preparing your personalised offer