Surname:
First Name:
Birthdate: (day/month/year)
Tel. (private):
Tel. (work):
Sex: Male Female
Full address (including city, code, country):

Fax:
E-mail:

Person to notify in case of emergency:
Full Name
Full address:

Tel.:
Fax.:
E-mail:

Have you previously taken a course at Russian language?
Where?
Please state briefly what experience you have in the language:
Please evaluate your level!:
0   1   2   3   4   5  
When do you intend to use this language?

In which line of business are you engaged?

What professional qualifications do you have?

Start date (day/month/year)
Finish date (day/month/year)
Number of weeks
Intensive Course: Yes  No
Individual
Group

Please select accommodation:
Apartment
Host family
No accommodation required

Arrival date (day/month/year)
Smoker: Yes    No
Special requirements (medical conditions, special diet, allergies, pets)

Do you wish to use the transfer service?
On arrival: Yes   No
On departure Yes   No
Arrival date
Arrival time
Flight Number