ImmerActive © Learning Experience:
November 10 - 16, 2007.

Your fee of PLN 4500* includes the complete, 7-day ImmerActive © language program. To reserve your place(s), please complete the reservation form and return to us by October 10 , along with your non-refundable deposit of PLN 1000 per student. The balance of all remaining fees must be paid no later than October 20 th, 2007.

Student name:
Student nationality:

Contact details (business / private):

Company name (if applicable):

Address:

Telephone: Mobile:

e-mail:

(select and complete one, as appropriate):

Individual Registration:

Complete ImmerActive © Program

Add a non-studying companion who will share a double room

or

Form of payment:

Bank Transfer:

Instytut Kształcenia Obcokrajowców

ul. Kopernika 3, 00-367 Warszawa.

Bank Śląski Oddział w Warszawie, nr konta: 83 1050 1038 1000 0022 4790 3046

Please fax your proof of payment to +48(22)828-5268

or

Credit Card payment may be made by telephone, or by fax: