Douglas - Institute - Learn italian language in Italy

APPLICATION FORM

Students must register at least 30 days before the start of the course.

Surname*

Name*

Nationality*		Passport N.
Date of issue		Place of issue

Date of birth

Place of birth

Sex	Female Male

Email*

Address

Zip Code

Town/City

State

Tel.*

Fax

I’m interested in the following course:

INTENSIVE COURSE (6 hours of lessons a day)

STANDARD COURSE (4 hours of lessons a day )

INDIVIDUAL COURSE (Hours of lessons to be agreed)

COMBINED COURSE(class + individual)
(4 Hours of lessons a day)
c = class / i = individual

Accomodation preference

an apartment - residence
hotel
farm holiday
campsite
other

For the period from * to*

All parts marked with an * must be completed for a correct registration.