Forms

Terms and Conditions of Participation

Applications should reach ISTITUTO EUROPEO possibly
30 days before the beginning of the course.

 FIELDS MARKED WITH * ARE REQUIRED!

 Name:*            
 Last Name:*       
 Sex:*              Male       Female
 Date of Birth:*   
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	Jan
	Feb
	Mar
	Apr
	May
	Jun
	Jul
	Aug
	Sep
	Oct
	Nov
	Dec

 Nationality:*      
 Company / School: 
 Profession:*      
 Smoker:*           Yes      No 
 Allergies:         
 Vegetarian:*       Yes      No 
 Address:*         
 City:*            
 Province:          
 Postal Code:*     
 Country:*         
 Tel:*              
 Fax:               
 E-Mail Address:*   
 
 Knowledge of Italian:* 
  None    Some    Average    Good 
 Mother Tongue:*  
 Other languages spoken:*  

 Write here the ID code number of course(s)
 chosen,preferably separated by a comma:* 
  
 (e.g.: to choose the Yearly Course and the 
 Course of Italian Wine write: 26L, 31V) 
 
 

 PLEASE USE EUROPEAN DATE FORMAT (DAY/MONTH/YEAR)
 (e.g. Xmas = 25/12/2003)

 From:*  dd/mm/yyyy
                                  
 To:*    dd/mm/yyyy

                    

 All the supplementary, professional and
 cultural courses are reserved only for
 the students enrolled in a language course. 
 
 
 Accommodation: 
 
 I would like the school to assist
 me with an accommodation:* 

 
 If 'Yes' please complete the following:

Individual 
    Apartment

Apartment with 
    other students

Room type:

Single Room

Double Room

Family

Room type:

Board:

Single Room

Breakfast

Double Room

Breakfast 
    and Dinner

Pension 
    (Hotel)

Room type:

Board:

Single Room

Breakfast

Double Room

 

 Other requests:  

 I learned about ISTITUTO EUROPEO through:* 
 Internet 
 Italian Cultural Institute 
 Agent or Agency >>> 
 Consulate 
 University
 former students 
 other:

 Payment:*

 To enrol it is necessary to pay the 50% of the chosen course(s) and the registration fee of €70.

 
 PAYMENT:
 
 Registration fee

 plus

 This amount in €:
  Euro

  
 International Post Money Order
 International Bank Cheque
 Bank Transfer

 (For the validity of your inscription,
  we kindly ask you to send us by fax,
  a copy of the payment of the deposit.
  As soon as we receive it, we will send
  our confirmation e-mail).

 Eurocard/Mastercad 
 Visa/Bancamericard 
  

 
 Card Number: 

 

                          

                            
CVV2: 
                            

                          
                        
                     
                        

 Expiry Date (mmyy): 
 m = month --- y = year


 Card's Holder NAME and SURNAME: 
  


 Date and Place:
 


 
 
 Signature 
______________________________________ 
 (necessary only if you're going to
 print this form and send it via fax)

*
I accept the

Terms
and Conditions of Participation