Enrolment form 2008

I.- Personal details

Gender: Age: Nationality:

Name:

Surname:

Address: Street

Zip code: City:

Country: Phone:

Fax: E-mail:

Profession or studies:

Hobbies:

Allergies : (e.g. dogs/cats).

Special medical o dietary requirement:

Do you have any special needs? :

I smoke
I do not smoke
I will accept a family that smoke

II.- Knowledge of spanish

none
very little
little
intermediate
good
very good

III.- Were and how did you learn about IELE?

If other, please specify:

IV.- Course details: Course type

A B C D E F G 

H I   J K L Ll M

Start date: Day Month Year

Until: Day Month Year

Total weeks hours per week

V.- Accommodation (Supplement 35 €) Yes No

Please, fill in your preferred accommodation type:

Family: half board full board
Apartment
Shared flat
University residence

Start date: Day Month Year

Until: Day Month Year

VI.- Transfer (Supplement 45 € Seville) Yes No

Arrival date: Date of arrival

Hour Place

Flight number Airline

VII.- Payment

Money order
Bank transfer
Bank cheque (in Euros)
Credit Card. Please indicate:

Type (Visa or Mcard):
Card number:
Card expiry date (Month/Yea):

I have read the conditions and agree to abide by them