APPLICATION FORM FOR HOMETUITION

APPLICATION FORM FOR OTHER COURSES.
Family Name 
First Name 
Sex Male Female  
Date of birth
month day year
 
Place of birth 
Nationality 
Occupation 
Address
Town and Zip code
Country 
Telephone 
Fax 
E-mail 
Commencement date of your course  from  to 
Date of arrival in Florence 
Date of departure 
Do you have any special request regarding your meals?
Do you have any special request regarding your accommodation?
Where would you like to stay?
in Florence 
in a village in the countryside near Florence   
Do you need a pick-up service?  
 yes from Florence airport (50,00 €)   
 yes from Florence railway station (50,00 €) 
 yes from Pisa airport (130,00 €)    
 no 
Course Details
One-to-one
Two-to-one (applications only accepted if students have a similar level of Italian and register together)  
Name of student with whom you will study: 
Subject
General Italian
Business Italian  
Italian for Exams  
Other
How many hours per week do you wish to take? 
Knowledge of italian language:
none elementary intermediate advanced  
How long have you been studying Italian?   
Why do you need to study Italian?  
How did you find about Accademia del Giglio?   
Selected payment:  
international postal order  
bank transfer  
international cheque  
credit card (VISA/Mastercard or PayPal)  
Other requests:
 

I certify that the information I have given above is true and correct and that I have read the Terms and Conditions overleaf and agree to be bound by them:

yes  no   

I dati qui raccolti hanno la finalità di registrare l'utente, e attivare nei suoi confronti un servizio informativo.
Tali dati verranno trattati elettronicamente in conformità con le leggi vigenti (dlgs 196 del 30 giugno 2003 - G.U. 29/07/2003); tali dati potranno essere comunicati a soggetti preposti alla gestione del servizio in oggetto e diffusi esclusivamente nell'ambito delle finalità del servizio reso; l'interessato gode dei diritti di cui all'art. 7 del DLGS 196 del 30 giugno 2003; titolare e responsabile dei dati raccolti è l'Accademia del Giglio Snc, Via Ghibellina n°116, 50122 Firenze. Clicca qui per l'informativa completa sulla privacy.