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Enrolment Form

Internship Enrolment Form

International Singing Competition Enrolment Form

Brochure Request

Prospective Agents

Internship Registration Form

Terms and Conditions of Participation

 
 FIELDS MARKED WITH * ARE REQUIRED!


 Name:*                 
 Last name:*            
 Address:*              
 City:*                 
 State:*                
 ZIP / Postal Code:*    
 Country:*              
 Tel:*                  
 Fax:                   
 E-Mail Address:*       
 Date of Birth:*        
 Company / School:      
 Nationality:*          
 Passport N.:*          
 Soc. Sec. #:           
 Sex:*                   Male   Female
 Smoker:*               Yes  No    
 Vegetarian:*           Yes  No
 Any health problems ?: 
 Allergies ?:           
 Medications ?:

 In case of emergency, please indicate the name and the number of a person 
 that we can contact:
  Name:*               
  Tel:*                
  Relation:*           



 Knowledge of italian:*  None    Some    Average   Good
 
 Mother Tongue:*           
 Other languages spoken:*

Program of Choice:	  
 
Requested Program Length:	

Requested Start Date:



 Housing Request (optional):

 I would like the school to assist me with an accomodation:*    

Yes - by choosing "Yes", you agree to accept the Institute's Housing Rules & Regulations

No - by choosing "No", you are responsible for your own housing; click here for a list
        of Housing Agencies 



 If you chose "Yes" indicate the preferred housing option, if "No" disregard
 the chart below:

Individual Apartment
Apartment with other students	Room type:
	Single Room
	Double Room
Home-stay	Room type:	Board:
	Single Room	Breakfast
	Double Room	Breakfast and Dinner
Pension (Hotel)	Room type:	Board:
	Single Room	Breakfast
	Double Room


 Other requests:      

 I knew about I.E. through: 
		Internet
		Italian Cultural Institute
		Consulate
		University
		ENIT
		ex-students
		other:

 Payment:*  >>> Tuition Costs <<<  >>> Registration Procedure <<<

  
  CONVENTIONAL PAYMENT:
  
  In order to validate your registration, we kindly ask you to
  send us by fax, a copy of the payment of the tuition deposit.
  As soon as we receive it, we will send you a confirmation and
  a certificate of enrollment for visa application.

  I have already paid the amount of 50% of the total
  program cost of:
  
   €
  
  by

 International Post Money Order
 International Bank Cheque
 Bank Transfer

 
  PAYMENT WITH CREDIT CARD:

  I have already paid the amount of 50% of the total
  program cost of:
  
   €
  
  with

NOTE:
The information you fill in the form will be sent to ISTITUTO EUROPEO under SSL after being encrypted using the Advanced Encryption Standard (AES) with a Key size of 256bit: that is the highest security level adopted on Internet today.

		
		
  
 Mastercad
 Visa/Bancamericard


  
  
  Card Number: 



                          
                            CVV2: 
                            
                          
                        

  Expiry Date (mmyy): m = month --- y = year


  Card's Holder NAME and SURNAME: 


  Date and Place: 




  Signature ____________________________________________________

  (necessary only if you're going to print this form 
  and send it via fax)