Personal information Surname * First Name * Birthdate * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025 Year Tel. (private) * Tel. (work) Sex * Male Female Full address * City and Code * Country * Fax E-mail * Person to notify in case of emergency Full Name * Full address Tel. * Fax E-mail * Brief Have you previously taken a course in Russian language? * Yes No Where? Please state briefly what experience you have in the language Please evaluate your level! * 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? Course start and length Start date * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year202520262027 Year Finish date * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year202520262027 Year Number of weeks * Intensive Course * Yes No Course type * Individual Group Accomodation Please select accommodation: * Self-catering apartment Host family simple Host family premium No accommodation required Arrival date * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year202520262027 Year Departure date * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year202520262027 Year Smoker Yes No Special requirements (medical conditions, special diet, allergies, pets) Travel and transfer Do you wish to use the transfer service? On arrival * Yes No On departure * Yes No Arrival date MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year202520262027 Year Flight Number GENERAL CONDITIONS & INFORMATION Deposit: 150 Euro course deposit, and (if applicable) an accommodation deposit and the accommodation registration fee, must accompany this application. These deposits will be fully refundable if notification of cancellation is received 30 days prior to arrival. In the even of the student cancelling a reservation for host family accommodation, two full weeks notice must be given. Failure to do so will result in a cancellation charge equivalent to one week. Odessa Language study Centre does not accept responsibility for any loss or injury however caused. Students should arrange for their own travel and medical insurance. Once a course has commenced lessons cannot be postponed, assigned transferred or refunded for any reason. FINAL CERTIFICATION I agree to be responsible for my tuition fees as well as all other incidental costs incurred by me including, but not limited to, accommodation and/or host family fees, telephone calls, airport pick-up charge and injury, debts or damages caused by or due to my actions. * Please, check your email. If you will not receive the confirmation, please, check your Spam folder. If you will not find confirmation in it, please, send email to info@studyrus.com and we'll forward it ASAP. Thank you! How many days are there in a week? * Submit
