Registration Form
Name
＊
Family Name
＊
You are
＊
male
female
Nationality
Age
Please select
under 25 years old
25-40 years old
40-60 years old
over 60 years old
Zip code
-
Address
Tel
＊
-
-
Fax
-
-
Cell phone
-
-
Computer email
＊
Cell phone email
Occupation
office worker/civil servant
student
homemaker
retired
other profession （
）
You would like
＊
Japanese classes
To participate in the next “Soiree de France”
If you want to enroll in a
language class, which one?
※
(Choose from the ATP schedule
and indicate the language,
the subject, the level, the day,
the hour)
the subject
basic grammar
alphabets
the level
Please select
1
2
3
4
5
the day
Please select
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
the hour
Please select
08:00~09:30
09:45~11:15
11:30~13:00
13:30~15:00
15:15~16:45
17:00~18:30
19:30~21:00
When would you
like to begin?
immediately
next month
next trimester
How much time have you
already studied Japanese?
less than a year （
months）
from 1 to 2 years
from 2 to 3 years
from 3 to 4 years
from 4 to 5 years
more than 5 years
If you already speak
(a little)Japanese,
where did you learn it?
secondary school
university
language school
with a private teacher
alone, with a textbook
How did you find out
about ATP
＊
ATP website
advertising billboard
ATP flyer
another internet site （
name
）
newspapers or magazines （
name
）
restaurant（
name
）
friend
other（
）
Comments or questions
