“More information”

Send this form to EUROSPEAK Brussels, Ghent or Antwerp and we will provide you with the information you need by e-mail or post. 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
E-mail
Telephone
Street
Number
Box
Postal code
City

Target language*

Language you want to learn

And, if possible, also
My level at this moment
	Absolute beginner
	Elementary
	Intermediate
	Advanced

Why do you want to do this language training course?
	Work
	Private
	Education

Name company / school
Street
Number
Box
Postal code
City

I would like to receive more information on*

	a tailor-made course
	an intensive course
	a functional module
	an 'open' group course
	language by telephone
	language councelling
	e-learning
	a course for expats
	coaching
	1 week intensive 12-18 years
	1 semester +18 years
	a junior course 3-12 years
	a school project
	a language project for a specific organisation
Other, please specify

Eurospeak

Have you already taken classes at Eurospeak?
	yes
	no

Remarks

Messages (this might include your specific needs, goals, any remarks,...) or questions


Contact

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