'Gaeltacht' Week 2007

Name
Address
City State Zip

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

Age if under 16

Please check here if you are a first time attendee or if you are
updating ANY contact information. Otherwise, we will not change
any of your information in our records.

Information to help us place you in the correct class:

Where do you attend classes?
With whom do you study?

Are you?

Level in Irish:

How long have you studied Irish?
No Previous Study Months Years

Ability:
On a scale of (low) 1 (beginner) to 10 (fluent), how would you rate your level of Irish?

Please mark off all of the following that pertain to your Irish language skills.

Odd words and phrases Can understand a bit

Can speak a bit Can read & write a bit

Very simple conversation Can read & write better than converse

Some Fluency:

In class:

Fáinne Óir

Má tá suim agat iontráil ar scrúdú an fháinne óir, déan pointeáil anseo:

RideSharing:

I can take passengers from:
I need a ride from:

Return this Form, with check payable to:

Ethel Brogan
56 Derick Drive
Fishkill, NY 12524-1002
(845) 897-5457

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

REGISTRATION FORM

Information to help us place you in the correct class:

Level in Irish:

In class:

Fáinne Óir

RideSharing: