Enrolment Form - Italian course - Istituto Linguistico a Padova

ITALIAN LANGUAGE COURSES ENROLMENT FORM

Please fill in the form below to enrol in our Italian language courses. It is important to fill in as many fields as possible.
NB – Enrolment shall become effective as soon as payment for at least one month of course has been made. Advance payments can be made online, through PayPal, by bank transfer or by international money order.
Should you wish to attend lessons for less than one month, please pay at least one week’s fee in advance.

☆ Personal Details

First name*

Surname*

Place of birth*

Date of birth* (gg/mm/aaaa)

Nationality*

Passport Number

Full address*

e-mail*

Telephone*

Fax

☆ I wish to attend an Italian language course…

I wish to attend the course commencing on*:

2017

2018

I wish to enrol for:*:

(seleziona la tua scelta ☑︎ )
1 MONTH (€ 600,00/month)
1 WEEK (€ 150,00/week)
SPECIAL OFFER - 4 months (€ 2.200,00)
SPECIAL OFFER - 6 months (€ 2.500,00)
SPECIAL OFFER 1 year - 12 months (€ 4.000,00)

Please state the number of consecutive months or weeks in which you wish to attend: (e.g. 2 months, 3 weeks, ...)

I require accomodation*:

(select ☑︎ )
YES
NO

If yes, please choose the type of accommodation:

☆ I would like to pay…*

(select ☑︎ )
… with Credit Card (PAYPAL)
… by bank transfer
… by international money/postal

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Notice on consent: In compliance with the provisions of Legislative Decree 196/2003, we would like to inform You that the provided data shall be processed, exclusively for the purposes for which they have been collected, and to keep you informed on our new or other services. Data shall be stored confidentially and shall not be transferred to third parties.
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Credit Card (PayPal):

Italian Courses

Dati bancari:

INTESTATARIO: Istituto Linguistico Bertrand Russell

BANCA: Deutsche Bank; Corso Matteotti 21, 35122 Padova

IBAN: IT 20 F0 31 04 12 10 00 00 00 08 22 00 6

BIC o SWIFT: DEUTITMMPAD

ITALIAN LANGUAGE COURSES ENROLMENT FORM

☆ Personal Details

☆ I wish to attend an Italian language course…

**I wish to attend the course commencing on*:**

**I wish to enrol for:*:**

**I require accomodation*:**

☆ I would like to pay…*

PAY NOW

Credit Card (PayPal):

Dati bancari:

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