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| Registration Form |
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| First Name: |
* |
| Last Name: |
* |
| Date of birth: |
(mm/dd/yyyy) |
| Profession: |
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| Company Name (if applicable): |
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| Is the company paying for the classes: |
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| Where did you hear about us: |
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| Address: |
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| City: |
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| State: |
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| Postal Code: |
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| Phone Number (Work): |
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| Phone Number (Home): |
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| Mobile Number: |
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| Best time to contact you: |
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| Email: |
* |
| Password |
* |
| Confirm Password |
* |
| Student Registration Form |
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| You are: |
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| Native language: |
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| Additional language and skill level: |
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| Briefly state your objectives in learning
French: |
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| Briefly describe any previous French language
education or experience: |
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| How would you describe your French language
skill: |
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| Which class are you registering for (please indicate the time, day and location) |
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I read the policies of the Active French
and I accept and agree with them |
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