This document is an enrollment form for an online English language learning program for European trade unionists being offered between May 1, 2012 and October 31, 2012. It requests contact information for the individual enrolling and their organization, including affiliation, address, billing address, telephone, email, and website. Participation fees are listed as 150 euros for individuals from Western Europe and 75 euros for individuals from Central and Eastern Europe. Upon submitting the completed form, an invoice will be sent and login instructions provided once payment is received.

1. ETUI EDUCATION ENROLMENT FORM PLEASE TYPE OR WRITE CLEARLY
To all organisations affiliated to the ETUC
ONLINE ENGLISH LANGUAGE LEARNING PROGRAMME FOR EUROPEAN
TRADE UNIONISTS - ELEMENTARY TO UPPER-INTERMEDIATE LEVEL
1st May 2012 – 31st October 2012
Course reference: 1252-036
Name of contact person:
Organisation (in your own language) and in abbreviation:
Address (work):
Billing address (invoice for inscription fee):
Affiliation: please indicate the Confederation or European Industry Federation to which
your organisation is affiliated
Telephone: (work) Fax:
E-mail:
Organisation’s web site:
Participation fee FOR SIX MONTHS
Western Europe: 150€ /person
CEEC (Central and Eastern Europe) : 75€/person
Payment of registration:
An invoice will be sent to the organisation upon reception of the enrolment.
Log in instructions will only be sent once we have received payment.
It is essential that you mention in your payment order the number of the
invoice and customer reference number.
Date Signature
ETUI aisbl is financially supported by the European Union