FEBRUARY WEEKEND REGISTRATION FORM

 * indicates required field.
   Name *
Address *
     City * State * Zip *

Phone [Day]:    Phone [Night]:
E-Mail: *

Má tá suim agat iontráil ar scrúdú an fháinne, déan marc anseo.
Please check if this Your are a first time attendeeor if you are updating ANY contact information
Please Note - You will be asked to provide an emergency contact name and telephone number upon arrival.
Age if child under 16 years old
Where do you study?
Teacher's Name
Not counting breaks, how long have you been studying Irish (Years) (Months)
Place an [X] if you are: Self-taught?    Schooled in Ireland?    A Native Speaker?
Using the guide below, how would you rate your level of Irish:
1 = True Beginner
2-3 = Some study, but still a beginner
4-6 = Intermediate and can converse some 7 = Somewhat Fluent
8-9 = Good Fluency
10 = Very Readily Fluent and/or Native Speaker

Please place an [X] beside ALL of the statements below that reflect your Irish Language level
Total Beginner
Only odd words & phrases
Can understand and speak just a bit
Can read and write just a bit
Can have only a very simple conversation
Can coverse for a few minutes, with much effort
Can readily converse for 5-10 minutes
Fluent, but grammer is weak
Cainteoir Líofa
Cainteoir dúchais

PAYMENT


Adults - $115.00 Students Under 16 - $70.00 Day Students - $70.00 Saturday Only - $50.00

You can register on the Web and pay by credit/debit card or print out this form and pay by check or money order.

Register on Web with Credit/Debit Card and PayPal

Print Form and Pay by Check:
make your check payable to: Daltaí na Gaeilge and mail it to:
Daltaí na Gaeilge
Liam Guidry
279 Park Ave.
Elberon, NJ 07740

If confirmation of your reservation is required, please enclose a stamped, self-addressed envelope with your Registration Form.

Questions?

Call Liam at (732) 571-1988 or Pádraig at (732) 291-5426.
Information and Directions
Events
February Weekend | Teachers Workshop | Advanced Speakers Weekend
May Weekend | June - Irish Saturday | Summer Week
FEBRUARY Weekend

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