for the license to take part in the Primalingua Project school year 2010/2011 Starting date: 15.09.2010

1. Upon receipt of the application no later than 31.07.2010, we will send you an invoice (license fees see pricelist).
2. The application will be accepted when payment is made within 14 days of receiving the account.
3. Upon receipt of the invoice amount you will receive the license package including:

• Username and password for the learning platform school year 2010/2011
• the teachers manual 
• comprehensive technischal support from sprachinstitut dialoge for the duration of the school year

Please note, that number of participating schools is limited. Positions in the programm will be allocated according to receipt of the applications.

Please complete the following form, fields marked with an asterix * are required.

	Data of the participating school
Name of the school:*
Street address:*
Zip code:*
City:*
State:
Country:*
Headmaster:*
Responsible teacher:*
	Data of participating students
Age of students:*
Learning language:*	--Bitte auswählen--GermanEnglishFrench
	Communication
Email:*
Phone:*
Website:
	Your message / questions
Message: