Gaeltacht Melbourne 202024–27 Eanáir/January

DÁTAÍ Praghas luathchosach: roimh 1 Samhain 2019 Foirm íocaíocht:⁊ roimh 1 Nollaig 2019.DATES Early-bird rate: before 1 November 2019 Forms & payment: before 1 December 2019.

Sonraí Pearsanta ⸙ Personal DetailsAinm as Béarla (roghnach):

Name in English (optional)

Ainm as Gaeilge (roghnach):Name in Irish (optional)

Ainm ar d’ainmchlib: ❑ Gaeilge ❑ EnglishName on your name tag

Seoladh:Address

Ríomhphost: Guthán:E-mail Phone

Teagmhálaí Éigeandála ⸙ Emergency ContactAinm: Guthán:Name Phone

Pacáiste ⸙ Package LuathchosachEarly-bird

IomlánFull

❑ Lóistín (lóistín, gach béile teagasc)⁊Live-in (accommodation, all meals & classes)

$445 $470

❑ Lóistín + Seomra dúbailte (2 daltaí)Live-in + Double room (2 students)

$890 $940

❑ Lóistín + Seomra dúbailte (dalta lóistéir)⁊Live-in + Double room (1 student + guest)

$750 $775

❑ Gan lóistín (lón, dinnéar teagasc)⁊Non-resident (lunch, dinner & classes)

$220 $250

Ag roinnt seomra dúbailte? Ainm do chomrádaí:Sharing a double room? Name of your room-mate

Foirm ar leith do gach duine seol aon íocaíocht amháin ⁊ ⸙ Use a separate form for each person and send 1 payment.

Má tá lóistín ag teastáil uait ar tréimhse taobh amuigh den chúrsa, beidh táille $75 an seomra in aghaidh an lae air. Is riachtanach é a iarraidh ar an bhfoirm seo agus an méid breise a íoc in éineacht le táillí an chúrsa.If accommodation is needed outside the course period, an extra charge of $75 per room/day will apply. The extra amount must be requested on this form and included in your registration payment.

Laethanta sa bhreis: Tá oíche eile ag teastáil uaim ar na dátaí seo:I require extra nights on these dates

Riachtanais cothaithe ⸙ Dietary requirements❑ Feoilséantach ❑ Véigean ❑ Gan ghlútan/Céiliach ❑ Gan táirgí déiríochta

Vegetarian Vegan Gluten free/Coeliac Dairy free

Riachtanais ar leith eile:Other special needs

Rang ⸙ ClassLe do thoil, roghnaigh do rang de réir do chumais. Níl cead agat athrú rang a iarraidh ach amháin i ndiaidh freastal ar an gcéad rang. Is faoin gcoiste is faoi na múinteoirí an cinneadh sin agus ní cheadófar athruithe rang i ndiaidh an chéad lae.

Please select your class according to your level of competence. You may request a change of class only after attending your first class. All decisions will be at the discretion of the committee and the teachers involved and there will be no changes of class after the first day.

❑ 1. Absolute beginner ❑ 4. More complex conversation/writing❑ 2. Few words & phrases ❑ 5. Proficient or fluent❑ 3. Basic conversation/writing

Ag freastail ar rang Gaeilge faoi láthair? ❑ Níl ❑ Tá—Múinteoir:Do you currently attend an Irish class? No Yes—Teacher

Cén chaoi ar chuala tú faoi Ghaeltacht Melbourne? How did you hear about Gaeltacht Melbourne?

❑ Ó bhéal / Word of mouth ❑ Nuachtlitir / Newsletter ❑ R-phost / E-mail❑ Facebook ❑ Suíomh Idirlín / Website:❑ D’fhreastail mé ar scoil samhraidh cheana / Previously attended a summer school

Íocaíocht ⸙ PaymentAn modh íocaíochta is fearr linn: Ríomhaistriú Airgid go…Preferred payment method: Electronic Funds Transfer to…

C.U.A. (Credit Union Australia)BSB: 814282 Account number: 10597015Account name: Irish Language Association of Australia

TÁBHACHTACH: Cinntigh go bhfuil d’ainm/sloinne sa réimse tagairte agus na litreacha GM ina dhiaidh sin. Cuir ar ais dúinn an dá leathanach líonta chuig: eolas@gaeilge.org.au.

Mura féidir leat íocaíocht RAA a dhéanamh, téigh i dteagmháil linn chun modh eile a shocrú. Dearbhóimid do chlárúchán trí r-phost nuair a thagann an íocaíocht isteach inár gcuntas. Seolfaimid r-phost eile amach i mí na Nollag le mioneolas faoi imeachtaí na scoile.

IMPORTANT: Please make sure your name is in the payment reference field followed by the letters GM and return both completed pages of this form to: eolas@gaeilge.org.au.

If you are unable to pay by EFT, please contact us to arrange an alternative payment method. We will confirm your registration by e-mail once your payment reaches our account. We will send a further email in mid-December with more detailed information.

Polasaí Cealaithe ⸙ Cancellation PolicyMás gá duit do chlárúchán a chur ar ceal, tabhair fógra dúinn chomh túisce is féidir. Gearrfaidh an Ollscoil táille orainn ar fógra déanach cealúcháin.Tabhair faoi deara:

If you need to cancel after registering, please provide as much notice as possible. We will still be charged by the university, for late notification of cancellation.Please note:

Fógra níos lú ná 30 lá—aisíoc 50%Fógra níos lú ná 2 lá—gan aisíoc

Less than 30 days’ notice—50% refundLess than 2 days’ notice—no refund