Italian Language Schools Scuola Leonardo da Vinci. Learn Italian in Italy

REGISTRATION fOR
SCUOLA LEONARDO DA VINCI COURSES

PART 1: PERSONAL DETAILS

	Mr. Mrs. Ms.
First Name:
Family Name:
	Date of Birth:
Day:
Month:
Year:

Nationality:
Mother Tongue:
Profession / Studies:
Home address:
City:
Zip code:
Country:
Phone:
Cellular:
Fax:
E-mail:
In case of emergency please inform:
How did you hear about Scuola Leonardo da Vinci?
If you find us on Internet, please specify where:
If "others" or "via an agency", please specify:
Why did you choose Scuola Leonardo da Vinci?

PART 2: ITALIAN LANGUAGE COURSES

I wish to enroll at the school located in:

Please fill in one application form for each city of choice in case you want to enroll for different locations. N.B.: You can book several courses. Please use the following 3 fields.
Course 1: I wish to enroll in the following course:

If you enroll for a "Professional Course", please select the professional field:

	Starting Date:
Day:
Month:
Year:
Number of Weeks:

Course 2: I wish to enroll in the following course:

If you enroll for a "Professional Course", please select the professional field:

	Starting Date:
Day:
Month:
Year:
Number of Weeks:

Course 3: I wish to enroll in the following course:

If you enroll for a "Professional Course", please select the professional field:

	Starting Date:
Day:
Month:
Year:
Number of Weeks:

Would you like to enroll to additional courses?
Special request/observations:

PART 3: MY KNOWLEDGE OF ITALIAN

Have you already studied Italian?	No Yes
	If 'Yes' please complete the following:
University/School:
Street:
Zip/Post Code:
City:
Name of the Italian teacher:
Self evaluation: (A1/A2... = Ability level according to the assessment scale of the European Language Portfolio)
Are you interested in Italian Language Diploma examinations:	No Yes

PART 5: PAYMENT

Note that if you are registering more than 21 days before the beginning of the course, we require the payment of the registration fee of 70 Euro. If you prefer, you can also pay the total course fees at once.

Note that if you are registering less than 21 days before the beginning of the course, we require the payment for the total course and registration fees.

PART 5: PAYMENT BY BANK, POST, CHEQUE

I have already paid the amount of: Euro
by means of:	Banker's Cheque Post Money Order Via Bank (incl. transfer cost)

PART 5: PAYMENT BY CREDIT CARD

Please charge the ammount of: Euro
by means of the following Credit Card:
For security reasons, please fill in the appropriate form with your credit card details (* and, in the case of Amexco, also the additional number), and fax it to the following number of our registration centre: +39 - 055.290.396

PART 6: TO SEND ENROLLMENT

My registration implies the acceptance of the General Conditions of Participation as mentioned in the Scuola Leonardo da Vinci web site and brochure.
Place:
Date:
I herewith confirm my enrollment at Scuola Leonardo da Vinci:

PART 7: ABOUT THE PRIVACY

Consent in accordance with Art. 23 of D. Lgs. 196/2003. The person concerned, having received the information furnished by the data processing owner in accordance with Article 13 of D.Lgs. 196/2003, hereby consents to the processing of his/her personal data for the purposes indicated in the aforesaid informative note. He/she also consents to the communication of his/her personal data for the purposes and to the subjects indicated in the informative note.

REGISTRATION fOR SCUOLA LEONARDO DA VINCI COURSES

REGISTRATION fOR
SCUOLA LEONARDO DA VINCI COURSES