First name:
Surname:
Full Address:
Town and State:
Post Code / Zip Code:
Telephone:
Fax:
Email:
Date of birth:
Nationality:
Occupation:
Mother tongue:
Other languages known:
   
KNOWLEDGE OF ITALIAN
 
none basic intermediate good very good
   
Studied when and where:
 
years: months: hours/day:
 

I would like to enrol in the following course:
 
GROUP COURSES
 
EG/40 Group Language Course
to:
weeks:
EG+I/60 Combined Course
EC/20 Conversation Course
EI/One to One Course
50 Plus
 
ACCOMMODATIONS
 
I would like the following accommodation:
 
 
APARTMENTS (please specify for how many persons, how many rooms, price limit, etc):
 
Special notes concerning accommodation:
 
I am coming by car: Yes No
 
Please make a reservation for my car (ferryboat Piombino - Portoferraio - Piombino):
 
Model and lenght of the car: no. of passengers:
Day of arrival: time:
Day of departure: time:
 
I will pay the reservation/ticket in EUR cash upon arrival on Elba
 
Can we give your name to other students who would like a lift? Yes No
 
How did you find out about Centro Fiorenza?
 
Please send me your detailed brochure:
by e-mail
by mail
 
 
Send