Card Registration for the courses of the Istituto Linguistico Mediterraneo

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I authorize the Istituto Linguistico Mediterraneo to treatment of my personal data in accordance with Italian Law (D.L. nr. 196 - 30.06.2003). My personal data will be used with the only aim to promote its programs of study and must be cancelled if I make an explicit request about it.

Istituto Linguistico Mediterraneo
Via C. Battisti, 3 CP 209, I-56100 Pisa
Tel. +39 050 500399 - Fax +39 050 48157
Email info@ilm.it - www.ilm.it

Personal Information
Mr.* Mrs*
Name*		Surname*
Date of birth*	/ /	Place of birth
Nationality		Native Language
Job		Allergies or special diet
Passport n°		valid until	/ /
Address		Email*
Postal Code		City
State		Country
Telephone		Fax
Arrival	/ /	at:	:
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Language courses (please choose up to 3 courses) [view the calendar]
From: N° week:
From: N° week:
From: N° week:
Courses culture
(NOTE: You can enroll in these courses only if enrolled in a course of Language)
From: N° week:
Preparatory course for admission to Italian University (only in Pisa)
(NOTE: To sign up for the course P/2 or U/2 must have a good knowledge of Italian language)
From: N° week: For the Italian Faculty of:

The following questionnaire is optional and has statistical aims
What is your knowledge degree of Italian language?
Comprehension	Speaking	Grammar
If you have already studied Italian please write the Institute's name and address where you studied (if you can, please indicate your teacher's name)
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Housing

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N° week

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Payment [view the price list]

I paid in advance 30% of the course and accommodation prices plus tuition fees for a total of Euro

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Students who need study visas should pay the entire cost of the course in advance at registration

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Online Subscription

Personal Information

Language courses (please choose up to 3 courses) [view the calendar]

Courses culture

Preparatory course for admission to Italian University (only in Pisa)

The following questionnaire is optional and has statistical aims

Housing

Transfer

Payment [view the price list]

Note