Enrollment

Personal details

Name
Surname
Address
City
Country
Nationality
Sex	Male Female
Mother tongue
Other known languages
Date of birth
Place of birth
Telephone
E-mail
Fax
Profession

Please tick if you have previously studied Italian
If so for how long?
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Dates of courses

Select a starting date among those indicated, then state in number of weeks the term of your course. For those students who have previously studied Italian, it is possible to discuss and agree on a customized starting date, where special needs may arise.
Starting date:
If you have special needs, and only if you have previously studied Italian, you can choose a starting date different from those indicated.
I wish to attend a General Course for

General Courses

I wish to attend the general course:

Cultural courses

Please state your preferences - No monthly supplement is required for these evening courses if you are already attending a General course marked with a star in the previous section.

Courses in art and culture

State your preferences - For these evening courses we require a monthly supplement of € 155.00 - 205.00.
CUC - Italian regional cuisine VINO - Italian regional wines	AFF - The art of frescoes

Specialized courses

These courses are held separately from the above listed General Courses.

Select one of the following course times, valid only for Il Bel Canto.
Term for course Il Bel Canto:

Individual Courses and Mini-courses

These language courses are designed for single students or very small groups, their starting dates are flexible.

Starting date: Number of hours:

Select your method of payment

	International Telegraphic Postal Order
	Cheque (payable to "Idea Verona s.a.s.")
	Credit transfer

Accomodation
Accommodation options

Please state your favourite options (more than one, please)

1.
2.
3.
(*) from June to August only
(1) per week per person price
(2) per day per person price

I already have accommodation.

Smokers Non smokers Vegetarian Kosher	Other:
Medical conditions or allergies (describe)

I have read and fully understood the application terms and conditions which I agree to.

Name Surname Date: 06-09-10

Centro Studi IDEA VERONA - Lingua, Arte, Cultura Italiana
info@ideaverona.com - Tel: +39 045 8015352 - Fax: +39 045 8037497
Str. A. Provolo, 16 - 37123 Verona (ITALY)