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SuperJazyk, ltd. - online application

Customer:

Title:

Name:

Surname:

Street:

Post code/ZIP:

Phone number:

Mobile phone number:

E-mail address:

Date of birth:

School / company name:

Name of school / company:

Position / year of study:

Street:

Post code/ZIP:

Phone number:

Web address:

Company registration number:

Course:

Type:

Language required:

Level:

Specialization:

Required specialization:

Length of course:

Lessons frequency:

Lecturer:

Lecturer preference:

Location preference :

Please select the location:

Please select approach:

Preferred times of study:

Time	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
7:00 - 8:00
8:00 - 9:00
9:00 - 10:00
10:00 - 11:00
11:00 - 12:00
12:00 - 13:00
13:00 - 14:00
14:00 - 15:00
15:00 - 16:00
16:00 - 17:00
17:00 - 18:00
18:00 - 19:00
19:00 - 20:00
20:00 - 21:00
21:00 - 22:00

Payment conditions:

Course price:

Part-payment:

Type of payment:

Specific reqirements of customer / comments / additional information:

Your comment:

Agreement with personal data processing

I confirm that data is correct and I agree with terms and conditions of SuperJazyk, s.r.o

I confirm that providing of data is voluntary and I confirm that data can be processed and used by SuperJazyk, s.r.o according to law number 18/2018 (protection of personal data)

Agrreement is granted with no time restrictions and can be revoked in writing at any time

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