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

REGISTRATION FOR CENTRO PUCCINI COURSES

PERSONAL DETAILS

Mr. Mrs. Ms.

First Name:

Surname:

Date of Birth:
Day: Month: Year:

Nationality:

Mother Tongue:

Profession/Studies:

Home Address (Street):

City:

Zip/Post Code:

Country:

Telephone (Home):

Telephone (Work):

Facsimile:

E-mail Address:

How did you hear about Centro Giacomo Puccinii?

If you found us on the Internet please specify where:

If 'others' or 'via an agency' please specify:

Why did you choose Centro Giacomo Puccini?

COURSES:

Course 1: I wish to enroll in the following course:

If you choosed "professional courses", please specify from the list below

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

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

If you choosed "professional courses, please specify from the list below

Starting Date: Day: Month: Year:

Number of weeks:

PAYMENT:

Note that if you are registering more than 30 days before the beginning of the course, we require a deposit payment of 70 Euro. If you prefer, you can also pay the total course fees at once.

If you are registering less than 30 days before the beginning of the course, we require the payment for the total course fees.

I have already paid the amount of EURO by means of:

Cheque internacional
Orden de Pago Postal
Bank transfer

To: centro culturale g. puccini srl
Bank: intesa sanpaolo (P.zza M.D’azaglio, 44 IT-55049 Viareggio (LU), tel +39 0584 325711)
sban: IT71 I030 6924 8000 7810 9260 124
swift: BCITITMM

My registration implies the acceptance of the "Terms and Conditions of participation" as mentioned in our Web site or brochure.

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.

Place and date: