Enrolment Personal Details Name*: Please, enter a valid input. Surname*: Please, enter a valid input. Phone*: Please, enter a valid input. Email*: Please, enter a valid input. Address*: Please, enter a valid input. Nationality*: Please, enter a valid input. Sex: M F Profession: Date of birth*: Please, enter a valid input. Place of birth*: Input non valido Course Details Languages known: Knowledge of Italian: none a little average good very good Chosen course: Standard course Combined course Intensive course Individual course Orbetello-Florence Orbetello-Siena Orbetella-Rome Orbetello-Perugia Junior 50+ Cooking Sport Art & Craft School groups Other Languages From: to: Accommodation Details In host family: No Yes single room double room with breakfast with halfboard Shared apartment: No Yes single room double room with use of kitchen Other: No Hotel B&B Farm House Private Apartment single room double room Max price: Smoker: No Yes Allergies: No Yes I have heard about OrbitLingua from: Payment Details (see general conditions) OrbitLingua Unicredit - Orbetello - Cod. ABI 02008 - CAB 72322 IBAN: IT64C0200872322000101403508 SWIFT: UNCRITM1F32 Deposit: I haven't sent the payment yet I have sent € 150 as advance payment (bank transfer) Payment date: General conditions: 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 OrbitLingua to use the datas I have given for own use. Accept Don't accept Further comments and request: Send
