WE ARE CURRENTLY EXPERIENCING TECHNICAL DIFFICULTIES.
PLEASE COPY AND PASTE YOUR COMPLETED APPLICATION FORM IN AN EMAIL MESSAGE ADDRESSED TO: school@italianoit.it
WE APOLOGISE FOR THE INCONVENIENCE!

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	Application Form  Name Surname Date of Birth gg 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  /  mm 01 02 03 04 05 06 07 08 09 10 11 12  /  yyyy 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 male: female: E-mail Place of birth Tel. Nationality Fax Mother tongue Permanent address My level of Italian language ----------level----------- absolute beginner elementary intermediate advanced I would like to enroll in the following --------Course--------- Intensive Semi Intensive Small groups Individual Evening If you decide for a special course, please specify the subject From: to: I would prefer the following accommodation: ---------------------none--------------------- Single room (with use of kitchen) Single room (no use of kitchen) Double room (with use of kitchen) Double room (no use of kitchen) I will arrive with my car: no:yes: Allergies: no:yes: smoker: noyes: I sent a deposit of Euro 100,00 by postal Money Order (or Eurocheque) to Associazione Professionale Didattica, Via Procaccini 26/2, 40129 Bologna Italy. I sent Euro 100,00 as a deposit paid by bank transfer to: Associazione Professionale Didattica IBAN: IT 54 N 06385 02417 07400017073A  BIC:  IBSPIT2B  with BANCA CARISBO (Cassa di Risparmio di Bologna) filiale Mercato Via Fioravanti 22, I-40129 Bologna  Date
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