Name:
Last name:
Date of Birth:
Nationality:
Address:
Zip code:
Town:
State:
Country:
Tel.:
Fax:
e-mail:
Passport N°
Expiration date:
Profession:
I heard about your school through:
My Current knowledge of the Italian Language:
I would like to enroll to the following course
which will be held at your school in Cascina from al

I do not need accommodation

I would like you to help me find an accommodation (indicate two possibilities):
Family Room with Italian breakfast
Half board
Room in a shared flat with use of the kitchen
Hotel **
***
****
If possible, I'd like a single room
(If single rooms are not available the school will automatically book
a bed in a double room)


I have paid the 30% of the total cost of the course and the enrollment fee (€35) by:
International Money Order addressed to the secretary of the school
Western Union
Deposit in your current account (send Transfer Reference Number)

I have read the regulations of the school and agree on them.

By the Italian law 196/03 I consent to the treatment of my personal data by "Hello! Language Center" with the aim of promoting its study programs.

 

Date _____________ Signature____________________________________