Register


1. Personal information


First name(s):
Family name:
Sex: male female
Date of birth: --
Nationality:
Address:
Telephone (with area codes):
Fax (with area codes):
Email:
Occupation:
Names and addresses/phone numbers of relatives or friends who may be contacted in case of an emergency (in your home country or in Poland):
What languages do you speak?

Have you studied Polish previously?
yes no
If yes, please state for how long and how many hours a week:
What is your present command of the Polish language?
Speaking
Listening
Reading
Writing

How did you learn about PROLOG?

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2. Language course details


A. SESSION SELECTION

Which course session do you wish to enrol in (please tick all that apply)?
ZIMA 1: 14th February - żółć 27th February 2010
ZIMA 2: 28th February - 13th March 2010
ZIMA 3: 14th March - 27th March 2010
ZIMA 4: 28th March - 10th April 2010
ZIMA 5: 11th April - 24th April 2010
ZIMA 6: 25th April - 08th May 2010
LATO 1: 20th June - 3rd July 2010
LATO 2: 4th June - 17th July 2010
LATO 3: 18th July - 31st July 2010
LATO 4: 1st August - 14th August 2010
LATO 5: 15th August - 28th August 2010
LATO 6: 29th August - 11th September 2010
LATO 7: 12th Sempember - 25th September 2010
LATO 8: 26th September - 9th October
LATO 9: 10th October - 23th October

B. PRICES, CALCULATION OF TUITION RATE
The regular price for a two week session is € 299.

Please note that we have introduced 4 tuition reductions:

  • 1. Returning student discount (10 %) – one session costs € 269.

  • 2. Multiple sessions discount (10%) – does not apply to the 1st session - each session costs € 269.

  • 3. Student discount (10%), for students with a valid Student ID and under the age of 26 – each session costs € 269.

  • 4. NEW! Early registration discount (10%) - Applies to those who register and pay full fees 60 days prior to course commencement – the session costs € 269.


Note: one discount per student per session. These tuition discounts apply to all sessions of the Core Polish Language Programme only and do not apply to any other additional courses, tour or accommodation options.

Please check and fill in details of the applicable category below:

I am a returning student.
Please state date(s)/ session(s) when you previously studied with us:
I am taking part in multiple sessions during Winter/Spring 2010
I am a student under the age of 26
I have registered for the course and paid full fees 60 days prior to course commencement
Please check one of the following:
None of the above categories apply, course cost is €299.00 per session
One of the above categories applies, the total cost is € 269.00

C. SUPER-INTENSIVE OPTION

SUPER-INTENSIVE OPTION (one-to-one) 25 classes/45 min. each € 390.00
SUPER-INTENSIVE OPTION (group of two) 25 classes/45 min. each € 195.00

Subject to availability after the placement process. This is typically known after the first day of the course. Should we have a candidate for the group-of-two option who matches your level, lessons will begin on the second day of the course.

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3. Accommodation options


DO YOU REQUIRE ACCOMMODATION? yes no

If yes, please tick one of the following:

A. HOST FAMILY ACCOMMODATION
Please note that you may be hosted by either a family or a single person.


Single room without meals € 170/13 nights

Do you smoke?		 yes no

Do you mind young children?		 yes no

Do you mind cats or dogs?		 yes no

Do you mind living with other students from the course?		 yes no

B. PROLOG RESIDENTIAL ACCOMMODATION


Single room without breakfast € 270

Shared room without breakfast € 190 (per person)

C. SODISPAR APARTHOTEL & APARTMENTS IN OLD TOWN KRAKOW.

The cost is from 390 €. Please contact us for more details.

Note: The accommodation fee covers 13 nights

Do you have any disabilities/chronic illnesses we should be aware of?		 yes no
If yes, please specify/give details below:
Date and time of arrival at your accommodation:
Date and time of leaving the place of accommodation:

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4. Enrollment and payment of fees


IMPORTANT: While we require only deposits to register, all remaining fees must be paid upon arrival in Cracow (by cash, credit card or check).
If you pay by bank transfer, please note that the student pays all bank fees.

Our EURO account number is:
IBAN: PL 15 12401431 1978 0000 1045 4031.
SWIFT (BIC): PKOPPLPW

If you pay by credit card please send us by ordinary mail or by fax a signed copy of this application.

I wish to book the above course.

For the course:
a) I have done a bank transfer:
80 € deposit + the full fees ( €)

b) Please debit my credit card (this form to be printed out and send)
80 € deposit + the full fees ( €)

For accommodation:
a) I have done a bank transfer:
50 € deposit + the full fees ( €)

b) Please debit my credit card (this form to be printed out and send)
50 € deposit + the full fees ( €)

For super-intensive option:
a) I have done a bank transfer:
The full fees ( €)

b) Please debit my credit card (this form to be printed out and send)
The full fees ( €)

Bank transfer:
please enclose proof of payment

IMPORTANT INFORMATION: Since all wire transfer costs are to be paid by the course participant, people who register for the course are requested to choose the payment option OUR when ordering the wire transfer. Please note that the deposit is non-refundable.

IMPORTANT
1. PROLOG cannot confirm enrolment until the deposit is paid. Once the signed application with deposit is received, you will receive confirmation of receipt and official registration confirmation by email as well as the balance owed.

2. Depending on citizenship and/or country of residence students may wish to consider supplementary health /accident insurance for their stay in Poland

3. If you will not have reached the age of 18 by your course start date, please have your parent or legal guardian sign this document.
Than fax it to us on +48 126384550.

Additional notes/requests:

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