HOMEPAGE
PERSONAL DETAILS
Name: *
Surname: *
Phone:
Email: *
Address: *
Nationality: *
Sex
M
F
Profession:
Date of birth: *
Place of birth: *
COURSE DETAILS
Languages know:
Knowledge of Italian:
none
a little
average
good
very good
Chosen course:
Standard course
Combined Course
Intensive course
Individual course
Orbetello-Florence
Orbetello-Siena
Orbetello-Roma
From
to
ACCOMMODATION DETAILS
In host family:
No
Yes
[
Prices
]
single room
double room
with use of kitchen
with breakfast
with halfboard
Shared appartment:
No
Yes
[
Prices
]
single room
double room
with use of kitchen
Other:
No
Hotel
BeB
Farm House
Private apartment
single room
double room
Max Price/day Euro
Smokers:
No
Yes
Allergies:
No
Yes
I have heard about OrbitLingua from
PAYMENT DETAILS
OrbitLingua
Unicredit - Orbetello
Cod. ABI 02008 - CAB 72322
IBAN: IT64C0200872322000101403508
SWIFT: UNCRITM1F32
Deposit:
Payment date:
I haven't sent the payment yet
I have sent € 150 as advance payment (bank transfer)
I have read the
general conditions
and I accept them
According to the law n. 675/96 regarding the protection of the personal datas, I hereby authorize the Orbit Lingua to use the datas I have given for own use.
Accept
Don't accept
Further comments and request: