Italian Cultural Institute Singapore
I T A L I A N L A N G U A G E C O U R S E S
Registration Form
| Please, register me for the class _____________________________________________ |
| Mr/Mrs/Miss Name ________________________ Surname ________________________ MAILING ADDRESS _________________________________________________________ _________________________________________________________________________ TELEPHONE (Home) ________________ (Office) ______________ (H/P)______________ FAX _________________ E-MAIL _____________________________________________ Nationality _________________________ Passport/IC no. _________________________
Have you studied Italian before? _________ For how long and where? _______________ _________________________________________________________________________ How did you learn about the course? ___________________________________________
SIGNATURE ___________________________ DATE ______________________________ |
| For Office Use Term _________________________ Student Number _____________________________ Tutor's name ______________________________________________________________ Membership card no. _______________ Expiry ________________Paid ______________ Fee ___________________ Paid by ___________________ Date ___________________ Receipt no. __________________ Received by _______________ Books _________________ Paid by ___________________ Date ___________________ Receipt n. ___________________ Received by ________________ |
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Registration valid only upon receipt of payment·
Fees paid are not refundable nor transferable·
Italian Cultural Institute shall not be held responsible for changes in students' personal or work commitments which may result in him/her not being able to complete the course