Italian Cultural Institute Singapore
Request for individual lessons
| Preferred days
__________________________________________________________ Preferred time __________________________________________________________ Preferred date of commencement ____________________________________________ Duration (number of weeks) _________________________________________________ Number of persons (up to three) _____________________________________________ Previous knowledge of Italian ________________________________________________ |
PERSONAL DATA Mr/Mrs/Miss Name ________________________ Surname ________________________ MAILING ADDRESS _________________________________________________________ _________________________________________________________________________ TELEPHONE (Home) ________________ (Office) ______________ (H/P)______________ FAX _________________ E-MAIL _____________________________________________ Nationality _________________________ Passport/IC no. _________________________
How did you learn about the course? ___________________________________________
SIGNATURE ___________________________ DATE ______________________________ |
For Office Use Tutor's name ______________________________________________________________ Membership card no. _______________ Expiry ________________Paid ______________ Fee ___________________ Paid by ___________________ Date ___________________ Receipt no. __________________ Received by _______________ Books _________________ Paid by ___________________ Date ___________________ Receipt n. ___________________ Received by ________________ |