Via dei Due Macelli, 47/Iº piano
00187 Rome
Tel: +39 06 69941314
Fax: +39 06 69202174

ENROLLMENT

APPLICATION FORM
Please fill the form and send it; remember to fill all the mandatory fields, before to send this form*
*Name and Surname:
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Home address:
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*E-mail address
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Date of birth
Office address
Office Telephone
Type of courses:
Type of Course..from..toN° of weeks
Accomodation:
Accomodation wanted
single room in a flat single room in Hotel
single room bed & breakfast double room in a flat
double room bed & breakfastapartment
single room with a family residence
Smoker or no smoker ? Allergic to
Some more informations:
I have never studied Italian
I do not speak Italian
I speak Italian at level of
I have studied Italian
when:
where:
total hours:
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Payments:
I have faxed 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