When you decide to register: Print out a copy of this form, complete it and mail it along with photocopy of your deposit transaction: ITALIAIDEA Via dei Due Macelli, 47/I piano - 00187 Roma - Tel: +39 06 69941314. - You can also fax your registration to: Fax: + 39/0669202174

Application Form
                 
Name Surname M         F        
Date of birth Nationality
Home address
Telephone Fax E-mail
Work address
Telephone Fax E-mail
                 
I would like to enrol for the following course(s)
                 
Type of course From To N°of weeks
Type of course From To N°of weeks
Type of course From To N°of weeks
                 
Accomodation wanted :       Yes       No                 Please indicate first (1) and second (2) choice
                 
  Single room in a flat   Hotel       single room       double room
  Double room in a flat   Bed &Breakfast       single room       double room
  Single room with a family   Apartment   Residence
                 
  Smoker   Non-Smoker   Allergic to
                 
  I have never studied Italian   I do not speak Italian   I speak Italian at a level of
                 
  I have studied Italian: where   when   total hours
  How did you hear about Italiaidea?:
                 
  I forwarded a downpayment of 50 Euro           + Euro
  I enclose photocopy of Bank order forwarded to Italiaidea
  I enclose credit card details as outlined   I have read and accepted the regulations
                 
                 
   Date ________________________   Signature