Formulaire en anglais

What language?*

Name*

First name*

Name written on the letterbox

If your name is not on the letterbox, please indicate the name written.

Address*

Zip code*

City*

Mobile phone number*

Fixed phone number

Email address*

Birth date*

Nationality*

Residence permit*

(N, F, L, B, C, CH, others)

Native language*

Other languages

I can write in my native language*

I have already had french or german courses*

I have already had Red Cross french or german courses*

What are your availabilities?*

I would like to take course in*

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