Nome
Name
Vorname
 

Cognome
Surname
Name
 

Nazionalita'
Nationality
Staatsangehörigkeit
 

Data di nascita
Date of birth
Geburtsdatum
 

Professione
Occupation
Beruf
 

Indirizzo
Address
Adresse
 

Indirizzo di posta elettronica
E-mail Address
E-mail  Adresse

Tel. Fax mobile


Principante/Beginnner/Anfänger

Vorrei frequentare
I would like to attend
Ich wähle den
dal/from/bis al/to/zu  

Vorrei una sistemazione in
I would like accommodation in a
Ich möchte Unterkunft in einem/er

Pagamenti
Payments
Zahlungen

International Bank Cheque or Euro-Cheque made payable to: Accademia Lingua Italiana Assisi, Via S. Paolo, 36, 06081 Assisi.
bank transfer
UNICREDIT BANCA
Piazza del Comune, 06081 Assisi
IBAN: IT 84 J 02008 38273 000010169238
SWIFT: UNCRIT UNCRIT B1 J 46
intestato a: ACCADEMIA LINGUA ITALIANA ASSISI
All bank transfers must be made in students name.
Western union

A registration fee of € 50 for course only, or € 100 for course and accommodation, must accompany this form.

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