SURNAME
FIRST NAME
F
M
ADDRESS
TEL.
FAX
E-MAIL
DATE AND PLACE OF BIRTH
PROFESSION
'NATIONALITY
PASSPORT No.
II LANGUAGE
KNOWLEDGE OF ITALIAN
none
elementary
good
very good
I WOULD LIKE TO ATTEND THE:
basic course
intensive course
from
to
COMBINED = BASIC COURSE + PUCCINIANI®:
a)
b)
c)
or
Basic course + one on a special theme
I HAVE SENT or I ENCLOSE A CHEQUE FOR L. 210.000 EURO 108.46 AS ENROLMENT FEE.
I HAVE READ AND ACCEPT THE GENERAL CONDITIONS.
RICHIESTA DI PRENOTAZIONE D'ALLOGGIO - ACCOMODATION REQUIRED
Please indicate first (1) and second (2) choiche
family
hotel
flat
single
double
country house
with breakfast
with bathroom
with swimming pool
half board
non-smoker
smoker
Do you suffer from any allergy?
STATISTICAL INFORMATION
Why are you studying Italian?
How did you hear about the school?
How did you find our site?