イタリア語コース用申込書

イタリア語コースに申し込まれる方は、下記の申込書をご記入ください。 各項は、記入できるものは全てご記入くださいますようお願い致します。 〈注意〉 お申込みは、少なくとも一ヶ月分の授業料をお支払いいただくことにより有効となります。授業料の一部を前払いされる場合は、PayPalによるオンラインでのお支払い、銀行口座振込み、国際郵便為替による送金がご利用できます。 一ヶ月未満の受講の場合は、少なくとも一週間分の授業料を前もってお支払いください。

ご記入はアルファベット、算用数字でお願いします。

    ☆ Personal Details

    First name*

    Surname*

    Gender*

    Place of birth*

    Date of birth* (dd/mm/yyyy)*

    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*:

    2023

    2024

    I wish to enrol for:*
    (seleziona la tua scelta ☑︎ )

    1 MONTH (€ 700,00/month)
    1 WEEK (€ 200,00/week)
    SPECIAL OFFER - 4 months (€ 2.600,00)
    SPECIAL OFFER - 6 months (€ 3.600,00)
    SPECIAL OFFER 1 year - 12 months (€ 6.000,00)

    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…*

    (seleziona la tua scelta ☑︎ )

    … with Credit Card
    … by bank transfer
    … by international money/postal

    ___

    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.

    ___

    Please input the Captcha code in the image:

    captcha

    I have read and accepted the Privacy Policy.

    お支払い(送信と共に支払う場合)

    クレジットカード

    Dati bancari:

    INTESTATARIO: Istituto Linguistico Bertrand Russell

    BANCA: Intesa San Paolo; Agenzia 50383 VIALE EUROPA, 26 – 35018 SAN MARTINO DI LUPARI (PD)

    IBAN: IT55 H030 6962 8271 0000 0007 857

    BIC o SWIFT: BCITITMM

    SerbiaPortugalSpainRussiaJapanGermanFrenchEnglishItaly