Card Registration for the courses of the Istituto Linguistico Mediterraneo

PRIVACY_NOTE

The Istituto Linguistico Mediterraneo is authorized by me personally to use my personal data according to Italian law (DL nr. 196 - 30.06.2003), which will be used solely for the purpose to promote its programmes study. My data must be erased if I do explicit request.
I have read the regulation of the Istituto Linguistico Mediterraneo and I agree with 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:	:
Travel by car	yes no	Smoker *	yes no
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:

Knowledge of Italian language
What is your current level of knowledge of Italian language?
Comprehension	Speaking	Grammar
If you have already studied Italian, write the name and address of with whom you have studied (please indicate the name of) :
How did you find the site dell'Istituto Linguistico Mediterraneo?
If search engine, other site, University school, agency or other, please specify which:

Housing

I want to housing NO YES

Please indicate two options

First option

Second option

dal:

/ /

al:

/ /

N° week

Transfer

I need a transfer on arrival: no yes

Traveling by train by plane from: at: on: / /

train station airport of: n. flight/train:

I need a transfer on departure: NO YES

Payment [view the price list]

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

By:	* postal order International * bank transfer * Visa and Mastercard * Visa and Mastercard (only for Paypal users)

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

Note

I accept the privacy note	no yes *
	* Please copy the validation code in the image

PRIVACY_NOTE

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)

Knowledge of Italian language

Housing

Transfer

Payment [view the price list]

Note