1) PERSONAL INFORMATION:
Name:
Address:
Phone: Email:
2) PLEASE INDICATE YOUR COURSE CHOICE:
1) Dutch: Group 1 (mixed level beginners) - Tuesday 7-8 pm, Room 5033/34 (11 weeks, starting
26 January, €210)
2) Dutch: Group 2 (mixed level intermediate) - Tuesday 8-9 pm, Room 5033/34 (11 weeks, starting 26 January, €210)
3) PAYMENT:
Payments can be made:
a) by PayPal, via www.tcd.ie/Germanic_Studies/dutch (NB this incurs an additional charge of €7);
b) by cheque, bank draft or money order, payable to “TCD No 1 Account”.
Please send your completed form, and payment if applicable, to:
Dr Natalie Wynn, Department of Germanic Studies, Trinity College, Dublin 2.
4) PLEASE NOTE OUR T&Cs:


There is no admission to classes unless fees are paid in full.
All forms and payments must be received by 26 January 2016 at the very latest.
 Places will not be confirmed until both form and fee are received.
 All courses are run subject to demand. In the event of cancellation, fees will be refunded in full.
 In the case of non-attendance, refunds can be claimed up to Friday, 19 February, however an administration charge may be deducted. No refunds will be made after this date.
5) FURTHER INFORMATION: o Course content: Ms Alice Schutte, schuttea@tcd.ie
or 089 4638599 o Registration and payments: Dr Natalie Wynn, germanic@tcd.ie
or 8961373
For office use only: PMO __ BD __ C __ BT __ PP __ Ref ____________
Date rec ____________ ldmnt ____________ ack ____________