Untitled Document

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 (all housing is on a first reserved, first served basis)
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