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Registration form

Home Registration form

Course*
Title*
Surname (Maiden name)*
First name*
Social Security number*
Name of spouse
Date of birth*
Date Format: DD slash MM slash YYYY
Place of birth*
Country of birth*
Nationality*
Profession
Address (street and number)*
Postal code*
Locality*
Country*
Phone 1*
Phone 2
Email*
Do you have a voucher from ADEM, ONIS or MIFA*
- No, I do not have a voucher
- Yes, I have a voucher from ADEM or ONIS
- Yes, I have a voucher from MIFA
ADEM or ONIS voucher number*
MIFA voucher number*
Photo/scan of the voucher*
Drop files here or

Accepted file types: pdf, jpg, jpeg, png.
ATTENTION: for a validated registration you are obliged to send the original voucher within eight days by post to Moien asbl, 2, rue Batty Weber L-3493 Dudelange
Enter the code of the course that you currently participate in
You need to send us a copy of the voucher to moienasbl@pt.lu as soon as possible.
Administrative fee*
Price: 10,00 €
Total
0,00 €
Comments
This field is for validation purposes and should be left unchanged.

Cours pour adultes agréés par

Nos cours

Summer Intensive Courses
Luxembourgish Language Courses
Conversation Courses
Spelling courses
Nationality courses
Article 28 of the Law of 8 march 2017

Contact

2, rue Batty Weber
L-3493 Dudelange

Email: moienasbl@pt.lu

Frequently Asked Questions

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