Enrollment Form

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Formularz Rejestrowania

Enrollment Form

Fields marked with * are required
PERSONAL DATA
First Name*
Last Name*
Sex*	Male Female
E-mail*
Address (including Postal Code)*
City*
Country*
Phone*
Fax

COURSE INFORMATION
Course type*
Course duration*	(in weeks)
Start date*	dd/mm/yy
Language level*
Accommodation*	without meals 1 meal/day 2 meals/day (tick this only if you choose to live in a host family)
Special preferences	Please specify your requirements to a host family here (e.g. smoking/non-smoking, with/without babies and children, pets, etc.:

VISA INFORMATION
Date of birth*	dd/mm/yy
Citizenship*
Passport Number*
Occupation*
Work address*
Arrival before*	dd/mm/yy
Departure after*	dd/mm/yy

Important: For your visa support we need a copy of your passport (pages with your personal data and your photo). If you have extended your passport, please enclose a copy of a page with a stamp of prolongation as well. Please scan the pages mentioned afore in a .jpg, .gif or .bmp format and forward them to Ten adres e-mail jest ukrywany przed spamerami, włącz obsługę JavaScript w przeglądarce, by go zobaczyć .

Embassy/consulate

Please state which Russian embassy or consulate (city & country) you are going to apply to. Choose from the list here.
Please fill in these fields if you are planning to stay longer than 1 month:

Country of birth
County/region/state
Permanent place of residence
County/region/state

ADDITIONAL INFORMATION
Your hobby
Diet notes
Allergies
Native Language
Other Languages
Other notes

HOW DID YOU LEARN ABOUT US?
Via
Detailed	Please indicate the web site/search engine address as well as the key words you used to find us:

WSTECZ