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Home Registration form

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Phone

This field is for validation purposes and should be left unchanged.

Course*

Title*

First name*

Surname (Maiden name)*

Name of spouse

Social Security number*

Date of birth*

DD slash MM slash YYYY

Place of birth*

Country of birth*

Nationality*

Profession

Address (street and number)*

Postal code*

Locality*

Country*

Other country*

Email*

Phonenumber*

Do you have a voucher ?*

No, I do not have a voucher

Yes, I have a a voucher

Voucher number*

Photo/scan of the voucher*

Drop files here or

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 40 MB, Max. files: 1.

Do you have language leave?*

Yes

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

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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:

Total

Consent 1*

I made sure I signed up for the right class.

Consent 2*

I have read and agree to the terms and conditions and the rules of proper operation.

Cours pour adultes agréés par

Nos cours

Luxembourgish Language Courses
Summer Intensive Courses

Contact

2, rue Batty Weber
L-3493 Dudelange

Email: moienasbl@pt.lu

Frequently Asked Questions
Proper operation
Terms and Conditions