ENROLMENT FORM
FOR DEPOSITS PAID BY CHEQUE OR BANK TRANSFER
OR INTERNATIONAL POSTAL ORDER

All personal information will to be used exclusively by our secretariat for internal use.
You can add to or withdraw this information at anytime (Italian law 675/96).

Please fill in required fields. Thank you!

(*) Fields required
(*) First Name:  
(*) Surname:  
(*) Street:  
(*) City:  
(*) Zip Code:
Phone:           Fax: 
(*) E-mail:          
Date of birth (We accept students from 18 upwards.
Students under 18 are accepted only if accompanied by an adult or with written permission from their parents).
SEX     M F
(*) Nationality:  
Profession
Passport N°:
Date & place of issue:
Mother tongue:
Other foreign languages known:
Have you already studied Italian?
If yes, for how long?
 Course
I WANT TO ENROL FOR:
DATES 2009
Mark the period (or periods)
 Housing
I WISH TO STAY IN FAMILY: SINGLE ROOM (SUPPLEMENT € 13)
FURNISHED FLATS:
   

1) BANK TRANSFER:
 Banca delle Marche
Agenzia di Urbania
IBAN: IT47 GO60 5568 6900 0000 0004 545; SWIFT: BAMAIT3A

2) CHEQUE made out to:

Centro Studi Italiani
Urbania

 3) INTERNATIONAL TELEGRAPHIC POSTAL ORDER

Deposit paid by:

N.B. Please state the exact date of your arrival
in the comments section below
Add any comments, suggestions or questions.  

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