Getting to know each other...

Please note:
All information will be treated confidentially,
it simply helps us to arrange the allocation of rooms in our hostels.

Surname*
First name*
Street*
Town, Post code*
Date/Place of birth*
Telephone no.
E-mail adress
Nationality
Religion
Health insurance
Marital status
Education
Purpose of room rental
Duration of studies/training
Desired career*
Name of workplace/college etc.*
Address of workplace/college etc.
Name of mother/father
Address of mother/father
Telephone no. of mother/father
Name and telephone no. of contact for emergencies
Date of arrival*
Other comments
	* = obligatory

Kontakt

Ludwigstr. 15
70176 Stuttgart
Tel.: (0711) 66 96 710
Fax: (0711) 66 96 713
http://www.Blumhardt-Haus.de
E-Mail: info@blumhardt-haus.de

Johannesstr. 6
70176 Stuttgart
Tel. (0711) 66 96 730
Fax: (0711) 66 96 739
http://www.Blumhardt-Haus.de
E-Mail: info@blumhardt-haus.de