| PERSONAL INFORMATION |
| name |
|
| street
address |
|
| city
& postal code |
|
| country |
|
| phone
nr. |
|
| fax.
nr |
|
| cellphone |
|
| E-mail |
|
| nationality |
|
| date
of birth |
|
| sex |
|
| job |
|
| best
way to contact you |
|
| current
knowledge of spoken Italian
|
| current
knowledge of written Italian
|
| additional
language studied or spoken, included level : |
|
| COURSE
INFORMATION |
| Please
enroll me in the following language course in group |
| 1-
from
to
no. of weeks
|
| 2-
from
to
no. of weeks
|
| 3-
from
to
no. of weeks
|
| Please
enroll me in the following language private course |
| 1-
from
to
no. of hours per week
|
| 2-
from
to
no. of hours per week
|
| if
you have chosen a Two to One course, please, write the name
of your course mate :
|
| Please
enrol me in the following additional course(s): |
|
from
to
no. of weeks
|
|
from
to
no. of weeks
|
|
from
to
no. of weeks
|
| if
needed, please provide any further details of your requested
coursework: |
|
|
| HOUSING REQUEST |
|
from
to
|
|
from
to
|
|
from
to
|
| if
you have chosen a double room, please, write the name of your
room mate :
|
| please
advise any additional housing details needed : |
|
|
| alternative
choice
from
to
|
| TRAVEL
INFORMATION |
| will
you require an airport pick-up
if yes
|
| arrival
from (city)
|
| scheduled
time of arrival at Catania airport
|
| flight
number
|
|
for our records, if not by air, how will you be travelling ?
|
|
By clicking on "Send", I declare
-- I read and accepted all the terms
-- According to art. 10 of Italian Law 675/96, I authorize Babilonia to utilise my personal data in order to promote its programs
|
