Université d'été de Boulogne-sur-Mer

Important note : Once you have completed and submitted this on-line registration form, you will receive confirmation of its receipt within a week.. This notification is sent to your e-mail address on an individual basis (and not automatically) by Université d’été de Boulogne-sur-Mer staff, and ensures that your registration file is being treated. We promise to notify you of the receipt of your on-line registration form as quickly as possible. If you do not receive confirmation within a week, then there was probably a problem with the reception of your registration form. In this case, please notify us by e-mail at info@uebm.org or by phone. Thank you.

Pre-enrol directly online

This pre-enrolment allows you to book your stay for 15 days (provided we are not fully booked when we receive your online enrolment form). This online form also prevents you from fillng in a paper form.
Caution : every field regarding your personal details must be completed As soon as we receive your online form, we send you an e-mail to confirm you have pre-enrolled and inform you about availabilities.

To confirm your pre-enrollment, you must send – either by post or by e-mail in attached files – the following elements in the fortnight following your pre-enrolment:
- A 120 € deposit payable to l’Université d’été de Boulogne-sur-Mer. If your deposit is equal or superior to 50% of the total price (training + accommodation), you can pay the balance of course fee when you arrive. This deposit will be deducted from the total tuition fees. You can pay either by cheque, Eurocheque or bank transfer (in that case, if you ticked "bank transfer" in your pre-enrolment form, our bank details will be sent to you).
- 3 identity photos (with your name on the back) or a good quality scanned photo in JPEG or PNG format.
- A photocopy of your passport or some valid form of identification (ID card, etc.) or a good quality scanned document pasted in a Word or OpenOffice file.
- Proof of medical insurance (copy of European Social Security card for EU citizens) which can be sent later if you do not possess any insurance yet but we must receive it before your arrival.

As soon as we receive these documents, an official enrolment confirmation paper will be sent to you, along with some useful information to prepare your journey and your stay.

Please fill in the following form in French.

Thank you for your interest in our French language courses.
Welcome to the Université d’été de Boulogne-sur-Mer

Optional message you would like to send with your online pre-enrolment form.

Your contact details

Title :

Last name :

First name :

Date of birth : / /

Nationality :

Profession and studies :

Address : Address Postcode Town

Country :

E-mail address :

Phone number :

Fax :

Your Stay

1/ Do you come with pre-pared group ?

NO
Yes, Please, precise the group leader or the institution :

2/ Choose the French course you want to attend:

French course :

3/ Choose your date :

Period :

Other, please be precise* :

*your preference will be submitted to the Director who will decide wether your choice is possible or not. Starting date : 14th July 2008 / End of our courses : 15th Agust 2008

4/ Choose your accommodation formula :

Type of accomodation chosen* :

Other, be precise :

5/ Have you already spent some time at the Université d'été?

Yes, Year(s) :
No

6/ Indicate your level of knowledge in French:

Level :

7/ Do you intend to enrol to a DELF degree?

Yes
Choose the degree you wish to enrol to : No

8/ Would you like to attend the 80€ formula to prepare the chosen DELF degree?

Yes
No

Other Information

9/ Person to be contacted in case of emergency :

10/ Detail concerning your insurance company in the event of hospitalisation :

Name :

Address :

Country :

Phone Number :

Fax :

REMINDER : Insurance is compulsory (illness, hospitalisation and repatriation...) during your stay at the Boulogne-sur-mer Summer University.
You must send a copy of a proof of insurance at 7 weeks before your arrival.

11/ Do you have your own car?

Yes
No

12/ Information you wish to give regarding special requests :

Payment

I am sending the deposit Euro - minimum 200€ by :
Bank Transfer
Cheque
Eurocheque

The deposit must be paid in Euros; it will be deducted from the total price of your stay fees. (If your deposit is equal or superior of 50% of the total price (training + accommodation) you can pay the balance of the total price when you arrive.) 60 €/120€ will be retained for administrative costs, in case of cancellation. We will send you your invoice as soon as we receive your deposit. This one will be taken into account.
he bank fees amount to 19€ per cheque from a non-French bank account or per bank transfer from an bank account located outside the European Union.

Attach your files
To confirm your enrolment, you can send the following personal documents via this electronic form : a good quality scanned identity photo in JPEG or PNG format, a good quality scanned valid form of identification (passport, ID card, etc.) and a good quality scanned proof of medical insurance

Non, I will send these documents by post

I will send the missing documents or all the documents very soon by e-mail to
Yes, I attach these files (or some of them) now via this form

Your identity photo*:

Your identity document** :

Proof of insurance*** :

* Good scanned identity photo (Passport format in JPEG or PNG)
** Good quality scanned image of your passport or other valid identity document (front and back - for E.U citizens only) pasted in a Word or OpenOffice file
*** We do not need it immediately to confirm your enrollment but we must receive it seven weeks before your arrival

REMINDER
Your enrolment will be confirmed as soon as we receive your deposit, the copy of your passport and your photos.

	I have read and I accept the conditions of enrolment at the Université d’été de Boulogne-sur-Mer. See conditions of enrolment I confirm my enrolment according to the given instructions and the information I gave on this above form.
	I declare not to oppose the right for the Université d’été de Boulogne-sur-Mer to use photos of myself during my summer stay provided these photos are only used to promote the Université d’été’s activities (brochure, Internet website, etc.)

Optimized for

YOUR ENROLLMENT TO OUR LANGUAGE STAYS (ONLINE)

Pre-enrol directly online

YOUR ENROLLMENT TO OUR LANGUAGE STAYS
(ONLINE)