Registration form

Surname *

First name *

Email *

Telephone *

Date of birth *

Nationality *

Adresse in Lausanne or vicinity

Street and No.

Town and postal No.

Course required *

Years *

at the rate of (hours per week) *

Stays in French speaking countries *

from *

to *

The fees due amount *

This amount will be paid *

Fondé en 1962

école de langue
et de culture française