MAIL TO:
Alliance Française de St. Louis
8505 Delmar Blvd.
St. Louis, MO 63124

Class Registration Application
Term 2: Feb 18–Apr 29, 2012

 


Personal Information

Name:

Address:

City, State:

Zip code:

Home phone:

Work phone:

Mobile phone:

Email address:

 

Class Registration

Select from the following list the class(es) for which you wish to register:

Class #1:     

Class #2: 

Class #3: 

 

Tuition

Select one of the following rates:

For applications postmarked on or before Feb 16
  $174.00 per adult class

  $87.00 per children’s class

  $38.00 Travelogue

For applications postmarked after Feb 17

  $192.00 per adult class

  $96.00 per children’s class

  $38.00 Travelogue

 

Membership
Students are required to be a member in good standing. Please select your member status:

  I am a current member.  

 Renew / Join as a new member. Select one of the following membership levels.*

Individual

$45.00

Angel

$250.00

Family

$70.00

Patron

$500.00

Benefactor

$125.00

Life

$2,500.00

 

If registering for a family membership, please list spouse and/or children's names:

Spouse:

Child:

Child:

Child:


How did you hear about us? Internet Radio Newspaper Friend/Word of Mouth Reputation 

   

 

    Payment

Amount enclosed:

Payment method:

Mastercard / Visa / Discover # ex (mm/yy)

Check #

Cash

*Amounts donated above the Individual or Family level may be tax deductible according to IRS guidelines.

 

Signature:

 

Date: