ILM - Enrolment Form

Enrolment form
for preparation courses for admission examinations to Italian Universities

Printable enrolment form

	Mr.	Mrs.	Miss

Name:
Surname:
Date of birth
Address (Str.):
Postal code:
City:
Country:
Tel:
Fax:
E-Mail:

Present knowledge of the Italian language:
none	little	medium	good

		Pisa only	Select course .
P/6, 20 lesons perweek, 4 lessons a day, from 09.00 am to 1 pm
	24 weeks 500 hours	Euro 3.474
P/5, 20 lesons perweek, 4 lessons a day, from 09.00 am to 1 pm
	20 weeks 420 hours	Euro 3.055
P/4, 20 lesons perweek, 4 lessons a day, from 09.00 am to 1 pm
	16 weeks 340 hours	Euro 2.750
P/3, 20 lessons per week, 4 lessons a day, from 09.00 am to 1 pm
	12 weeks 260 hours	Euro 2.265
P/2, 20 lessons perweek, 4 lessons a day, from 09.00 am to 1 pm
	8 weeks 180 hours	Euro 1.800

**Accommodation**
Please do not reserve any accommodation

I would like to reserve accommodation (Please indicate two possibilities):
Family	bed and breakfast
	half board
Room in apartment, with common kitchen and bathroom
Apartment
Pension
Hotel

If possible, I would like a single room. (if single rooms are not available, the school will automatically reserve a bed in a double room)

Payment terms

I have paid an advance of 30% of the price of the course by:

International money order, addressed to: Istituto Linguistico Mediterraneo Via C. Battisti n° 3 - C.P. 209 I-56100 Pisa - Italia	Current Bank account

I declare that I have read the school regulations and accept them !

Comments

Courses Calendar and price-list Regulations Enrolment form Regulation Accommodation