Personal details |
| Mr. Ms. |
| Surname |
First name |
| Tel. |
Mobile phone |
| Fax |
E-mail |
| Profession |
Nationality |
| Address |
| Date and place of birth |
| Languages known |
| Knowledge of Italian none a little average goodvery good |
| |
Course details |
| I would like to enrol for the following course |
| Dal al |
| |
Accommodation |
| Room in a shared flat |
Single |
| Room with family |
Double |
| Hotel |
|
|
Other |
|
| Smoker Sì | No |
Allergies: |
| |
|
| |
Advance payment |
| |
I have sent € 150,00 as advance payment by bank transfer(*):
Orbitlingua
Banca di Roma - Orbetello
Cod. ABI 03002 - CAB 72320
c/c 651422/10
By International Money Order
IBAN: IT97L0300272320000065142210
SWIFT: BROMITR1F32
|
| Date of payment |
|
| (*) Proof of payment should be sent by fax : +39.0564.865557 |
| |
Comments and requests |
Further comments and requests:
|
I have read the general conditions and I accept them
According to the law n. 675/96 regarding the protection of personal data, I hereby authorize the Orbit Lingua to use the datas I have given for its own use.
|
