REGISTRATION FORM FOR DISTANCE LEARNING COURSES GERMAN Please fill in and sign this form and return it to: Goethe-Institut e.v. Bereich Multimedia und Fernlehre Germany Please proceed in this order: 1. Please save the form on your computer before filling it in. 2. Please complete all fields. 3. Save it again on your computer and print it out. 4. Sign the printed registration form on page 3. 5. Post your registration form to the address shown on the left. 1. MY PERSONAL DETAILS Mr Mrs Surname (as in passport)/familienname (wie im Pass) First Name/Vorname (wie im Pass) c/o Street/No./Straße/Nr Goethe-Institut e. V. Bereich Multimedia und Fernlehre T 0800 1800 800 (Toll free) T +49 89 159 21-560 (From abroad) F +49 89 159 21-643 fernlernen@goethe.de goethe.de/fernlernkurse Postcode (zip code)/city/plz/ort Tel. (incl. area code)/telefon (mit Vorwahl) Country/Land Fax (incl. area code)/faxnummer (mit Vorwahl) version december 2014 E-mail address/e-mail-adresse Occupation/Beruf Nationality, native language/nationalität, Muttersprache Date of birth/geburtsdatum Place of birth/geburtsort, Country of birth/geburtsland MY KNOWLEDGE OF THE GERMAN LANGUAGE I have already been learning German: No Yes, for... months... years... hours/week at the Goethe-Institut in... in (year)... And I have already passed an exam in German: No Yes, as follows:... TO TEST YOUR LANGUAGE LEVEL, please contact our customer service LINK. They will send you your access code for our online test free of charge and with no obligation. For the course Deutsch Online Aussprache it is not necessary to take a placement test. www.goethe.de Page 1 of 5 HOW DID YOU FIND OUT ABOUT OUR COURSES? on the internet from a Goethe-Institut in a newspaper/magazine at an exhibition/event from friends
2. COURSE SELECTION I would like to register for the course(s) I have checked below: Course / Level/ Duration / ZFU no. LINK Course fee in euros* (payment in instalments) LEARN GERMAN ONLINE Deutsch Online Individual LINK 638, per course level (2 Instalments) at levels A1, A2, B1.1, B1.2, B2.1 and B2.2 Registration number 431506 2. the following support language: English French Spanish Italian Russian Deutsch Online Aussprache LINK 285, Required: Level attained A1 max. 2 months Deutsch Online Grammatik LINK Required: Language skills mid C1 max. 9 months Registration number 4309063 Deutsch Online Fachsprache LINK Required: Level attained C1 Registration number 430806 590, (3 Instalments) 630, (2 Instalments) 2. to choose the following area of study: Medizin Jura Biologie Wirtschaft Natur Technik Psycholinguistik Deutsch Online Lehrkräfte LINK 370, Online group course Required: Level attained B1 10 weeks Registration number 441513 Due date for registration: 1 week before start of the course Prüfungsvorbereitung Online - TestDaF Required: Level attained B2 Registration number 4309063 * Please note the Conditions of Participation relating to course fees and payment. I would like to start the course on the following date: 12.01.2015 16.03.2015 11.05.2015 13.07.2015 14.09.2015 16.1 1.2015 480, (2 Instalments) Please note that our examination training is for preparation purposes only and does not include the exam itself. You are responsible for your own examination entry. Page 2 of 5 Goethe-Institut e.v. Bereich Multimedia und Fernlehre, Germany
2. COURSE SELECTION I would like to register for the course(s) I have checked below: Course / Level/ Duration / ZFU no. LINK Course fee in euros* (payment in instalments) LEARN GERMAN WITH TEXT AND EXERCISE BOOK Besser Deutsch Anfänger LINK 695, (4 Instalments) at levels A1-A2.1 max. 12 months Registration number 430405 Besser Deutsch Schreiben LINK at levels A2.1, A2.2, B1.1, B1.2, B2.1, B2.2, C1.1, C1.2, C2 max. 9 Months Registration number 426901 Besser Deutsch Schreiben Wirtschaft at level B2.2 max. 9 Months Registration number 426901 2. the following support language: English Spanish 3. to send/receive exercises and corrections: 590, per course level (3 Instalments) 2. to send/receive exercises and corrections: 590, per course level (3 Instalments) 2. to send/receive exercises and corrections: * Please note the Conditions of Participation relating to course fees and payment. Page 3 of 5 Goethe-Institut e.v. Bereich Multimedia und Fernlehre, Germany
3. PAYMENT REVOCATION BOOKING PAYMENT I would like to pay by credit transfer. in instalments (only in Europe, for all courses that last longer than 3 months) total sum I have already paid the course fee in the online shop. The order number is:... BOOKING You can only be registered for the course if you have checked all the boxes below: I hereby register for the course I have selected under 2 and confirm that the above declara-tions are complete and correct. I have read and accept the conditions of participation LINK. Place Date Signature of participant (NB: parent or guardian must sign for minors!) I would like to be informed by e-mail about future offers. You can cancel this consent at any time by informing us at Fernlernen@goethe.de. Place Date Signature of participant (NB: parent or guardian must sign for minors!) Page 4 of 5 Goethe-Institut e.v. Bereich Multimedia und Fernlehre, Germany CANCELLATION POLICY - DISTANCE LEARNING COURSES - Right of cancellation You have the right to cancel this agreement within fourteen days without specifying the reason. The cancellation period is fourteen days, starting on the day that you or a third party named by you not including the carrier, has received the first distance learning material; or in the case that the distance learning course is exclusively in digital form, starting with the day the agreement is concluded. In order to exercise your right of cancellation, you must clearly inform us (Goethe-Institut e.v., Dept. of Multimedia and Distance Learning, Dachauer Strasse 122, 80637 Munich, Tel.: +49 [0]89/ 15921-560, E-Mail: Fernlernen@goethe.de) of your decision to cancel this agreement (e.g. via letter, fax or e-mail). You can use the enclosed/attached sample cancellation form for this. The form is not mandatory, however. To comply with the cancellation period, it is sufficient to send your cancellation notice before the end of the cancellation period. Consequences of cancellation - If you cancel this agreement, we are to pay back immediately and within fourteen days all payments which have been sent to us, starting with the day we have received notification of the cancellation of this agreement; this includes all shipping charges (except for additional costs which result from choosing another type of shipping other than the least expensive standard delivery we normally offer). We will use the same method of payment for the refund which you used for the original transaction, except if we have agreed otherwise; you will not be charged any fees for this refund. We can refuse to refund you until you return the distance learning material or until we have proof that you have sent back the distance learning material, whichever is earlier. You are to immediately send back or hand over the distance learning material within fourteen days at the latest, starting with the day that you have informed us of the cancellation of this contract, to us or to Niedermaier Spedition GmbH, Rücksendung Goethe-Institut, Fuhrmannstr. 10, 94405 Landau an der Isar. To comply with the time limit, you must send the distance learning material within fourteen days, before the time limit has expired.you shall bear the immediate costs of sending back the distance learning materials. You shall only be liable for any diminished value of the distance learning material resulting from handling other than what is necessary to ascertain the nature, characteristics and functioning of the distance learning material. If you have demanded that services begin during the cancellation period, then you are to pay us an appropriate amount corresponding to services already rendered at the point in time when you informed us of your right to cancellation regarding this contract as a share of the total services foreseen in the agreement. End of cancellation policy
SAMPLE CANCELLATION FORM (If you wish to cancel the distance learning agreement, then please fill out this form and send it back to us.) To: Goethe-Institut e.v. Bereich Multimedia und Fernlehre Dachauer Strasse 122 Germany E-mail: fernlernen@goethe.de I/we (*) hereby cancel the distance learning agreement which I/we (*) have concluded Ordered on (*) / received on (*) Customer name Goethe-Institut e. V. Bereich Multimedia und Fernlehre T 0800 1800 800 (Toll free) T +49 89 159 21-560 (From abroad) F +49 89 159 21-643 fernlernen@goethe.de goethe.de/fernlernkurse Customer address Page 5 of 5 Goethe-Institut e.v. Bereich Multimedia und Fernlehre, Germany Date (*) strike out as applicable Customer signature (when sending via post or fax) www.goethe.de