Family Name

First Name

Male       ð

Female   ð

Date of birth

Nationality/Language

Home address

Telephone No

Fax No                          Email             

Address for correspondence/invoice (if different)

Telephone No

Fax No                          Email             

Occupation

Estimated present level

No of weeks        

Please list any special language needs :

Course required

Please tick

Tuition Fees

Arrival date/departure date

…………………………...…………….…...…….

Transfer service available on request

Standard courses

2 weeks – 30 hours

Intensive courses

2 weeks – 60 hours

Accomodation required

(to be paid directly)  Yes ð   No ð

 ð  Hotel ® € 287,00/378,00 HB per week, approx

 ð  Country guest house * ® € 270,00 HB  per week

 ð  Room in private home ® €  140,00 per week, approx

 ð  Bed & Breakfast* ® €  210,00 per week, approx

 ð  Flat ® €  175,00 for 2 weeks

* car needed due to location

For more detailed information about accomodation or please contact the school or visit  www.monferrato.org

Language and social programme

2 weeks – 30 hours + activities

Combination Course

2 weeks – 30 hours group + 15 h.

1 to 1

Business Italian

1 week – 30 hours                  

12 weeks programme

From elementary to advanced -180 hours                        

Supplementary week

1 week – 15 hours                    

Please indicate any special requirements you may have:

For more detailed information about courses, accomodation or transfer service please contact

Istituto di Lingua Italiana

Via Canina 13 – 15033 Casale Monf. -  Italy

Tel. ++39 142 453585 Fax ++39 142 70843

e-mail ilit03@tiscali.it

Cancellation. This must be made in writing to ILIT.  Fees will be retained according to when notice is received: 30 days or more € 150,00 deposit retained. 29-8 days  fees for one week retained. 7 days total fees retained.

Administration fee                   €          70,00

Tuition fee                               € …………….

Total                                        € …………….

- Proof of payment of € 200,00 deposit must be sent with this form.

- Total course fee must be paid at least 30 days before the course begins

I wish to pay the remaining sum of € ……………. by   Bank Tranfer   ð   Credit card  ð  Cheque ð

ILIT/English School

Cassa di Risparmio di Alessandria, Ag. di Casale 

CC 16215, ABI 06075 CAB 22600

Signature

Date