| name |
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| street address |
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| city & postal code |
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| country |
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| phone nr. |
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| fax. nr |
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| cellphone |
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| E-mail |
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| nationality |
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| date of birth |
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| sex |
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| job |
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| best way to contact you |
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| current knowledge of spoken Italian |
| current knowledge of written Italian |
| additional language studied or spoken, included level : |
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| COURSE INFORMATION |
| Please enroll me in the following language course in group |
| 1- from to no. of weeks |
| 2- from to no. of weeks |
| 3- from to no. of weeks |
| Please enroll me in the following language private course |
| 1- from to no. of hours per week |
| 2- from to no. of hours per week |
| if you have chosen a Two to One course, please, write the name of your course mate : |
| Please enrol me in the following additional course(s): |
| from to no. of weeks |
| from to no. of weeks |
| from to no. of weeks |
| if needed, please provide any further details of your requested coursework: |
| |
| HOUSING REQUEST (all housing is on a first reserved, first served basis) |
| from to |
| HOTEL SPECIAL OFFER PACKAGE |
| from to |
| if you have chosen a double room, please, write the name of your room mate : |
| please advise any additional housing details needed : |
| |
| alternative choice from to |
| TRAVEL INFORMATION |
| will you require an airport pick-up if yes |
| arrival from (city) |
| scheduled time of arrival at Catania airport |
| flight number |
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for our records, if not by air, how will you be travelling ?
| PLEASE, FILL THE FOLLOWING QUESTIONNAIRE. THANK YOU A LOT! |
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By clicking on "Send", I declare
-- I read and accepted all the terms
-- According to art. 10 of Italian Law 675/96, I authorize Babilonia to utilise my personal data in order to promote its programs
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