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Information form - Individuals

Mr Mrs Ms

*Name (first & last) :

*Adress :

*Post code & City :

*Email :
ex: mail@exemple.ch

*Phone :
ex: 022.555.55.55

Cell phone :

Student

*Name (first & last) :

*Date of birth :

*Current cursus :

*Degree
1st year 2nd year 3rd year 4th year 5th year 6th year 7th year 8th year 9th year 10th year
Primary College Lycée / Gymnase Apprentice Other(s) (please specify)
Other(s) :

*Discipline to coach :
French
German
English
Italian
Spanish
Mathématics
Accountability
Physics / Chemistry
Law
Economics
Other(s) (please specify)

Comments :

* Mandatory fields.