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ON-LINE ENROLMENT

Complete the information required, as accurately as possibile .
* mandatory.
I WISH TO ENROL IN A PROGRAMME SPECIFIED HEREUNDER

 
PERSONAL DETAILS  
Surname*:
 Name *:
Sex:
Date and Place of Birth *:
Age *:
 Nationality*:
Mother language*:
 Profession:
Address *:
 Home phone number :
Office phone number :
 Fax:
E-mail *:
 Company information: (if the invoice is to be addressed to the company)
COURSE DETAILS  
Level of Italian:
 Course location:
Type of course:


 Number of weeks of course:
Preferred starting  date of course*:
 I wish to do an exam preparation course CELI / CIC:

Do you want to partecipate in any of these extra activities:  
Music Art
Guided Tours Italian Cooking
ACCOMMODATION  
Family Hotel
Other Other (specify):
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room:
 board:
smoker:
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Health problems:
  
ARRIVAL  

Date of arrival:

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 Transfer:
STATEMENT

I have read and accepted the "General Conditions ".

* The undersigned authorises team lingue lecco srl, from this moment onward ,to use the personal data supplied herewith, even transmitting it to other organisations , in order to obtain information requested , on condition that it be used ,exclusively, for the fulfilment of the programme.

The undersigned authorises team lingue lecco srl to use the personal data supplied herewitheven for marketing, promotion and gathering of statistics