ENROLMENT FORM

Name ……………………….………………………………………................................M ( )  F ( )

Address...…………………………....................…………………………………....……...…..……

………………………………………………………………………………………...……………..

Place & date of birth…………………………………………...………………………………….….

Current or former occupation ………………………………………………………………………...

Tel/ fax.............................................................................................………………………………....

E-mail …...……………………………………………………………………………………….…..

Course date from ………… to .....................

Day of arrival ..................Time of arrival.......……………      bus ( )   train( )     car ( )     plane ( )     

Individual lessons []    hours per day ……… 

Group course: [] standard       [] intensive     [] super-intensive 

Specialised course …………………………………………….

Mother tongue ………………………………………………………………………………………

Knowledge of the Italian language

none  ( )     elementary ( )   intermediate ( )   advanced  ( )      very fluent ( )

If you have studied Italian before, please specify where and for how long

...................................................................................................…………………………………..…

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Please reserve me:

Hotel        ( )  single room         ( ) double room

Family  ( ) B&B      ( ) HB        ( ) FB

Apartment ( )  for ........ persons (availability on request)

Notes........................................................................................…………………………….…………

……………………………………………………………………………………………………….

I understand and accept the general conditions of participation

Date...................................Signature.......................................………………….…………………….