YIDDISH IN ALSACE Registration form

Mr / Mrs / Miss: ……………………..……………First Name: …………………….……….... Address: no., road…………………………….……………………………………………….... …………………………………………………………………………………………………... Town, postal code:.……………………………...………...Country:.………………………….. Phone no: ……………………………….………..Fax:.......………………………………........ E-mail: …………………………………………………………………………………………. Place and date of birth:.……………………………………………………………………….... Profession:. ……………………………………………………………………………………...

Fees : Language Courses, Workshops, Cultural Outings : • full fee:

380 Euros

• student fee: 280 Euros Deposit of 150 Euros to be sent before the 15th of june 2007 with the completed application form enclosed : Either by cheque to:

Théâtre en l’Air – Der LufTeater C/° M. Goldwaser 24, Rue Haute F - 67100 Strasbourg

or by money order to:

Crédit Mutuel Code Banque Code Guichet N° compte 10278

01084

Yiddish level : • Beginner: 1 • Middle:

2

• Advanced: 3 Chosen workshops in order of preference :

00076158545