Enrolment Form for Polish courses

Title (please circle) Mr Mrs Miss Ms

First name and surname .........................................................................

Name of course .........................................................................

What are your main objectives for this course?......................................................................

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I enclose £...................... payable to Polish Cultural Institute

............ for the book payable to Orbis Books (London) Ltd (for Improvers, Intermediate and Lower Intermediate)

Method of payment (cash or cheque) ...................................

Have you learned Polish before? If yes, where, and for how long?

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If your address/telephone/e-mail has changed, please put it below. If you haven't studied at the Institute before, please fill in this section.

Address ...............................................................................................

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Postcode ............................................................................................

Position, Institution .........................................................................

Tel. work .........................................................................

Tel. home .........................................................................

e-mail .........................................................................