::
Enrolment form
::
Request informations

• Enrolment form


Titre :
Mr Mme Miss

Name :

*


First_name :

*

Date of birth :
*
Place of birth :
*

Nationality :
*
 


PROFESSIONAL ADDRESS


Company's name :
*

Street :
*
Zip code :
*

City :
*
Country :
*

Company's email :
*

Phone :
*
Cellphone :
*
Fax :
*

Taxes Number for Company :
*


PERSONAL ADDRESS


Street :
*
Zip code :
*

City :
*
Country :
*

Email :
*

Phone :
*
Cellphone :
*
Fax :
*


Person to contact in case of emergency


Titre :
Mr Mme Miss

Name :
*
First name :
*

Street :
*
Zip code :
*

City :
*
Country :
*

Email :
*

Phone :
*
Cellphone :
*
Fax :
*


Additional informations in case of illness, handicap or allergy


More informations :
*


First language :
French English  


PROGRAM CHOSEN


More informations *:
20 weeks program :  10 weeks program  Short Trainings :


SELECT THE DESIRED COURSE


Would you like the school book a room for you ?*


Yes

No

If YES, more details please :

Hotel :

Hotel's name :
*

A room CFA BTP in PERPIGNAN :

Dates from :
*
au :
*


METHOD OF PAYMENT*

Cash :       Cheque :       Bank transfert :      Credit card :






Ecole internationnale de Pâtisserie Olivier Bajard - 335, rue Docteur Parcé - Agrosud - 66000 PERPIGNAN (FRANCE)
Tél: +33(0)6 03 20 26 62 / Fax: +33(0)4 68 21 57 61