CREIPAC - Centre de Rencontres et d’Echanges Internationaux du PACifique
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Last name	*
First name	*
Sex		malefemale
Address
Country
Tel
E-mail	*
Number of years french studied		0 1 2 3 4 5 6 7 8 9 10 year(s)
Number of weeks duration	*	1 2 3 4 week(s)
Proposed start date	*	(dd / mm / yyyy)
Accomodation type		(Please choose) With family (highly recommended) Rent a studio Hotel room By my own
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