Italiaidea: The Center for Italian Language and Culture Studies in Rome

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The Center for Italian Language
and Culture Studies in Rome

Corso Vittorio Emanuele II, 184
00186 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 sending this form*
*Name and Surname:
Nationality:
*Home address:
*City:
Telephone:
Fax:
*E-mail address
*Select
*Date of birth
Office address
Office Telephone
Office E-mail
Office Fax

Type of courses (or Leisure&Travel service):
*Type of Course	..from	..to	N° of weeks
	20	20
	20	20
	20	20

Some more information:

I speak Italian: Yes No

I have studied Italian: Yes No

How did you hear about Italiaidea:

Payments:

I have faxed a downpayment of 60 Euro + euro

I have faxed a downpayment of 80 Euro + euro

I enclose photocopy of Bank order forwarded to Italiaidea

I faxed the payment information

Payment online by credit card . euro

* I have read and accepted the regulations

Date

Accomodation:
Accomodation wanted Yes No
Alloggio scelto single room in a flat single room in Hotel single room bed & breakfast double room in a flat double room bed & breakfast apartment homestay w/ meals residence
Smoker or no smoker ? Smoker No smoker
Allergic to