Booking

Derzhavin Institute
Russian Language Schopol in St Petersburg

Save 5% on Your Course Fees

Pre-register now

The pre-registration is not binding in any way! Pre-registration requires no initial payment and it grants you a 5% discount!!!

Within the next 48 hours after you have submitted this form, Derzhavin Institute will contact you to confirm your pre-registration form has been received and to provide you with further instructions on how to formalize your registration to study at the school. The booking is made directly between the student and the language school.

DISCOUNT apply only when using this form!

PERSONAL INFORMATION

Your First Name:
Your Second Name:
Gender:
Nationality:
Date of Birth:
Occupation:
Address:
City:

State:
Zip/Postal Code:
Country:
Home Phone:
Fax:
E-mail:
Alternative e-mail:
Emergency Contact name:
Emergency Contact Phone:

PROGRAM ATTENDING

Program (according to the choices in the school description):
Number of weeks you wish to book: Starting date of classes:
Level: Objectives:
Additional Information*:

ACCOMMODATION

Please list your type of accommodation according to the choices in the school description:
Arrival Date for Accommodation:
Departure Date for Accommodation:

Medical Conditions:
Dietary Concerns:
Additional Information:

ARRIVAL (This information can be sent later)

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