Subscription form
If you wish to book a course online, please fill in the following form
Alternatively you can contact us at the following address:

Thema Language School
Rue de l'Hospioce Communal, 73. 1170 Bruxelles
E-mail: info@themalingua.be.
School Director : M. Olivier Guilmain

tel: 02.640.59.82 / fax: 02.640.59.87.

1. Personal details

First name:

Family name:

Address line 1:

Address line 2:

Town/City:

Postcode:

Telephone/Mobile
Allowed formats:
XXXX/XX XX XX
XXX/XX XX XX
XX/XXX XX XX
+XX X X...

E-mail:

Nationality:

Mother tongue:

Date of birth:

Language of study:

Dutch
English
French
Italian
Spanish

How long have you been studying the language?

Oral:

Written:

Have you attended a Thema course before?

Yes
No

If yes, which level did you follow?

100 101 200 201 300 301 400 401 500 501
When was it?

If no, where did you hear about Thema?

2. Course dates

I would like to start on the following date:

3. Which programme do you want to study?

Discover or Master the language [level 1-4]
27 hours / 3 hours once a week (Saturday morning 9 weeks)
27 hours / two times 2 hours 15 per week (Evening 6 weeks)

27 hours / 2 hours 15 once a week (Evening 12 weeks)

INTENSIVE PROGRAMMES
2-week intensive 2 hours 15 per day in the evening (22.5 hours)

1-week intensive 4 hours 30 per day (22.5 hours)
2-week intensive 2 hours 15 /Evening (22.5 hours)

4. Information for professional adults

Occupation:

Name of company:

Address of company 1:

Address of company 2:

Telephone with code:

Course objective:
technical
general
business
other:

Specialisation:
meetings
telephone
presentations
negotiations
conversation
other:

5. Any other information

Please use the space below for any information you feel is relevant to your booking:

Please copy the code: