ENROLMENT FORM
WITH CREDIT CARD

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

Please fill all parts of this form.

(*) Fields required
(*) First Name:   
(*) Surname:  
(*) Street:   
(*) City:  
(*) Zip Code:  
Phone:   Fax:
SEX: M F
(*) Nationality:  
Profession  
Passport N°:
Date & place of issue:
(*) 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).
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 WANT TO STAY IN FAMILY:  SINGLE ROOM (SUPPLEMENT € 13)
FURNISHED FLAT:


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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