Inschrijfformulier

Inschrijfformulier

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PERSONAL DETAILS

Mrs

Miss

Family name*

Firstname*

Date of birth (dd/mm/yyyy)*

E-mail*

Addres/Street

Town/City

Post/ZIP code

Country

Nationality

Phone 1*

Phone 2

Fax No

PROFFESIONAL DETAILS

Job title

Company name

Nature of business

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

STANDAR COURSES

LONG DURATION COURSES

COURSES WITH DISCOUNT

INTENSIVE PLUS COURSES

SPECIFIC COURSES

JUNIOR PROGRAMME

PROGRAM FOR GROUPS

FORMACION DE PROFESORES ELE

Start date (dd/mm/yy)

End date (dd/mm/yy)

Number of weeks

How do you judge your present language level?

HOW DID YOU LEARN ABOUT MALAGA ¡SI!

friends

advertisment (please, specify where)

internet

Link form

Other

ACCOMODATION

IN A SPANISH FAMILY

Single room

Double room (for two people booking together)

Triple room (for three people booking together)

Please, name your room mate/s

Half Board

Full board

YOUTH HOSTEL

Single room

Double room (for two people booking together)

Please, name your room mate

Breakfast only

Half Board

Full board

RESIDENCE

Single room

Double room (for two people booking together)

Please, name your room mate

Breakfast only

Half Board

Full board

SHARING FLAT WITH OTHER STUDENTS

Single room

Double room (for two people booking together)

Please, name your room mate

SINGLE APARTMENT

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

nights

Start date (dd/mm/yy)

End date (dd/mm/yy)

Number of weeks

I will arrange muy own accommodation

Have you any special health conditions or dietary requirements?

Other requirements

Do you smoke?

yes

TRANSFER SERVICE

Arrival transfer service

yes

Arrival flight number

Arrival flight date and time

Departure transfer service

yes

Departure flight number

Departure flight date and time

IF YOU WISH TO PAY BY CREDIT CARD

The total fees for the course of will be charged to the credit card. (You will be chargedwith an extra 3,75% to services). Please charge the fees to the following credit card:

Visa

Master/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 fees

Remaining fees for the course, amount

will be charged to the credit card.

I agree fees

I do not agree fees

AGENT CONTACT

I have been in contact with the following agent/agency:

Name

Address

Post/ZIP code

Town

Country

Tel No.

Fax No

E-mail

Additional questions to Málaga ¡Sí!

I have read the general regulations and accept the conditions they contain.

CLÁUSULA DE PROTECCIÓN DE DATOS DE CARÁCTER PERSONAL

En cumplimiento de lo previsto en la Ley Orgánica 15/1999, de 13 de diciembre, de Protección de Datos de Carácter Personal (LOPD), le informamos que los datos por Vd. facilitados se incorporarán a un fichero titularidad de IDIOMAS SI, S.L., debidamente inscrito en el Registro de la Agencia Española de Protección de Datos, con la finalidad de realizar funciones de gestión comercial y de facturación.
Los datos de carácter empresarial que nos facilite serán tratados de forma confidencial. IDIOMAS SI, S.L. adquirirá el compromiso de custodia fiel y cuidadosa de la documentación a la que tenga acceso y con ello, la obligación de que ni la documentación ni la información que ella contiene o a la que acceda como consecuencia del servicio prestado llegue en ningún caso a poder de terceros, a menos que así se haya autorizado.
Según lo previsto en los artículos 15 y siguientes de la LOPD, Vd. podrá ejercer sus derechos de acceso, cancelación, oposición y/o rectificación, enviando un e-mail a Dit E-mail adres wordt beschermd tegen spambots. U moet JavaScript geactiveerd hebben om het te kunnen zien. o mediante carta dirigida a la siguiente dirección: Idiomas Sí, S.L. Avenida Juan Sebastián Elcano, 23. 29017 Málaga. España

Thank you for filling out our application form. We will send you an rerolment confirmation by e-mail, fax or post as soon as possible.