Last Name:(please print)

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First Name:

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Sex:

__Male__/__Female__

Date of Birth
(month/day/year)

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Home Address:

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Street:

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City, State:

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Home Phone:

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Business Phone:

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Fax:

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Occupation

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Russian Language knowledge

(underline: speak, read and write as in mother tongue, can read and limited conversation, know poorly, don’t know)

Field (subject) You like to specialize

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Which class would you like to take?
Note: The instructor reserves the right to determine the appropriate class level

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What Time & Days are convenient for you?

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