“Meet a coordinator”

Send this form to EUROSPEAK Brussels, Ghent or Antwerp and we will contact you as soon as possible. Your personal information will only be used to process your request. We are committed to ensuring the privacy of all the information we collect. Some questions have multiple options. Fields indicated with an asterisk (*) are required to complete this questionnaire.

Coordinates

Name*
First name*
Function
Name company / school
Street
Number
Box
Postal code
City
Email*
Telephone (home)*
Telephone (office)
Fax
Mobile

Request

Language you want to learn:
And, if possible, also
Number of participants
Current level:
	Absolute beginner
	Elemantary
	Intermediate
	Advanced
When would you like the course to start?

I'm interested in:
	a tailor-made course
	an intensive course
	a functional module
	a open group course
	language by telephone
	language counselling
	e-learning
	a course for children or students
	a language project for a specific organisation
	a school project a course for expats
Other, please specify

Eurospeak

Have you already taken classes at Eurospeak?
	yes
	no

Message

Message (this might include your specific needs, goals, any remark,...) or question


Contact

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