Registration Form
PLEASE SEE www.CzechTalk.com for all current Registration Forms.
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Registration Form
Please return your Registration form and Payment to:
Anna Cooková
5525 Glenwood Ave
Stevens Point, WI 54482
USA
Please keep a copy for your records.
Jméno (Name):
Věk (Age): (optional)
Email (Email):
Telefoní Číslo (Telephone Number):
Adresa (Address):
Název kurzu (Name of the Course):
Místo konání kurzu (Location of Course):
Termín kurzu (Dates of the Course):
Způsob platby (Method of Payment):
For example: 10 hours over 10 weeks at $55/hour = $550.00
⃝ Cash $__________
⃝ Check $__________
⃝ Money Order $__________
⃝ PayPal $__________ Please email annacookova@gmail.com for PayPal instructions.
Introduction of yourself, and your interest in the Czech Language: