APPLICATION FORM
Please fill the form and send it; remember to fill all the mandatory fields, before to send this form*
Courses
Course plus accomodation
Name and Surname
*
Nationality
Home address
Place
Telephone
Fax
E-mail address
*
Select
Male
Female
Date of birth
Office address
Office Telephone
Office e -mail
Office Fax
l
Type of courses:
Type of Course
..from
..to
N° of weeks
l
Accomodation:
Accomodation wanted
yes
No
single room in a flat
single room in a Hotel
single room bed & breackfast
double room in a flat
double room in hotel
double room bed & breackfast
single room with a family
apartment
residence
Smoker or no smoker ?
Smoker
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 Italia
when
total hours
where:
How did you hear about
Italiaidea:
*
Payments
I have faxed a downpayment of 40 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
Italiaidea srl
via Due Macelli, 47/I° piano - 00187 Roma - Italy
Tel. +39-06-69941314; Fax +39-06-69202174