Scuola Dante Alighieri - Application Form

Application form

Please fill in required fields (*). Thank you!
All personal information will to be used exclusively by our secretarial officefor internal use.
You can add to or delete this information at anytime (Italian law 675/96).

Fill in this form and send it back to us. Thank You !

First Name (*)		Last Name (*)
Born in (*)		on (*)
Nationality (*)		Pass n. (*)
Address (*)		Post Code (*)
Town (*)		Country (*)
Profession (*)
Tel. (*)		Fax
Mobile Phone:
Sex (*)	Male Female	E.mail (*)

Knowledge of Italian
		none
		little
		medium
		good
		excellent

Where do you study/have you studied Italian?
Teacher::

I want to take part in the language course for the month of (*)

Intensive Italian Language Course, Accommodation in Double Room + 9 Guided Excursion + Cultural & Recreational Activities + Transfert from Castelraimondo Train Station (arrival)(*)
		4 weeks 1.330 Euro
		3 weeks 1.098 Euro from to
		2 weeks 898 Euro from to

		Double Room (in apartment with others students)
		Single Room (in apartment): +7,00 Euro per night
		Single Flat for 1 student: +16,00 Euro per night (kitchen, bath, bedroom)
		Single Flat for 2 students: +24,00 Euro per night (kitchen, bath, bedroom 2 pax) - Only studens travelling toghether

I enclosed the deposit for registration:

Payment of 148 euro by CREDIT CARD: Visa, Matercard, Amex, Diners

All your data, including your Credit Card, is encrypted and the transaction is secure.
Only pay on-line after the confirmation of the registration from the School by e.mail.

Bank transfer of 148 Euro:
Bank: Banca Marche - Via Favorino, 4 - 62032 Camerino (MC) - tel. 0737 636049
Branch: Camerino
Name: Scuola Dante Alighieri s.r.l.
Account number: 9879 ABI: 06055 CAB: 68830 CIN: V
Code IBAN:IT90 V060 5568 8300 0000 0009 879
BIC: BAMAIT3AXXX

Notes:

General Conditions

The Bookink will not be accepted without the receipt of the deposit (to be send by fax or mail)
Please note that bank charges may be incurred. Check with your bank how much this will be and add it to your deposit.
Enrolment will only be made when we receive payment of the deposit. We advise you to book as early as possible (with at least a two months’ notice before the start of the intended course) in order to guarantee you your choice of accommodation.
If the school is notified of a cancellation more than 40 days before the start of the course, the deposit will be refunded minus 30% for administrative, bank and postal charges.
No reimbursement will be given to students who leave after the start of the course for any reason.
Accommodation (included in the course fee) must be paid at the reception of Residence upon your arrival.
Students under 18 must have written permission signed by their parents.
The School accepts only Traveller's Eurocheques and International bank cheques made out to Scuola di Italiano Dante Alighieri s.r.l.
For Each Traveller's Cheque The school charges a fee of 0.60 Euro.
The payment of the total of the course can be done with credit card, the commission cost of this service is 3% of the total ammount.

Yes, I have read and I accept the Code of conduct concerning the use of personal information (Privacy Act n° 196 of 30 June 2003)

In completing this form I agree to the terms and conditions of Scuola Dante Alighieri

I've read the prospectus and the regulations and declare myself in agreement with them.

Scuola di Italiano Dante Alighieri s.r.l.
Kurse der Italienischen sprache und Kultur whonen vor ort
Niederlassung für die Abnahme der CELI Examen
der Universität für Ausländer von Perugia
Via Farnese, 17 - 62032 Camerino (MC) - ITALIA Tel./Fax +39 0737 642611
Sede Legale: Via Farnese, 17 - 62032 CAMERINO (MC) - ITALIA
Codice Fiscale e P.IVA: 01501180432
Segreteria: centroalighieri@scuoladantealighieri.org
Direzione (dott.ssa Anna Poeti): direzione@scuoladantealighieri.org