Application Form
* Required fields
PERSONAL DETAILS
Mrs Miss Ms Mr
Family name*
Firstname*
Date of Birth (dd.mm.yy)*
Address/Street
Town/State
Post/ZIP code
Country
Nationality
Tel. No. home
Tel. No. work
Cellular
Fax No.
E-mail*
Job title
First language
Other languages
Company name
Nature of business
NEXT OF KIN
Name
Tel. No
Address
FOR STUDENTS UNDER 18
Name of legal guardian
Tel. No
Cellular
ADDRESS TO WHICH INVOICE SHOULD BE SENT
Company
Department
Address/Street
Town
Post/Zip code
Country
Tel. No.
Cellular (Training Manager)
Fax No.
E-mail
ENROLMENT
Please select a course:
Start date (dd.mm.yyyy)
End date (dd.mm.yyyy)
Number of weeks
   
How do you judge your present language level?
HOW DID YOU LEARN ABOUT Alicante ¡SÍ!?
FRIENDS
ADVERTISMENT (please specify where)
INTERNET
By searching
Link from:
OTHER
ACCOMODATION
IN A SPANISH FAMILY:
Single room
Double room (for two people booking together)
Please name your room mate:
Half-board
Full-board
SHARING FLAT WITH OTHER STUDENTS:
Single room
Double room (for two people booking together)
Please name your room mate:
Flat for one or two people
IN A HOTEL (single room with private WC/shower):
2 star hotel **
3 star hotel ***
4 star hotel ****

Hotel required from
to = nights

I will arrange my own accommodation
Have you any special health conditions or dietary requirements?
Other requirements:
Do you smoke? yes no
IF YOU WISH TO PAY BY CREDIT CARD
The total fees for the course of will be charged to the credit card 2 weeks before the beginning of the course. For later enrolments the full fees will be charged immediately. (You will be chargedwith an extra 3,75% to services).
Please charge the fees to the following credit card:
Visa
Mastercard/Eurocard
Name cardholder
Address cardholder
Card number
Expiry date year
ENROLMENT FEES
Enrolment fees: 90 EUR, will be charged to the credit card immediately after reception of your Application Form.
I agree I do not agree

Remaining fees for the course, amount: EUR
will be charged to the credit card 2 weeks before the beginning of the course.
I agree I do not agree

AGENT CONTACT
I have been in contact with the followingagent/agency:
Name
Address
Post/Zip code
City
Country
Tel. No.
Fax No.
E-mail
Additional questions to Alicante íSí!
I have read the general regulations and accept the conditions they contain.

 

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Idiomas Alicante íSí! - Alicante íSí!
Calle General Lacy, 8 Primero
ES-03003 Alicante
SPAIN

Tel +34 965 125889
Fax +34965 924287
E-mail: info@Alicante-si.com