Società Dante Alighieri 134,Old Bakery Street, Valletta VLT1457 - Tel. 21 238 408 email:info@dantemalta.org
APPLICATION FORM - MODULO D’ISCRIZIONE
Course: _________________ADULTS BEGINNERS SUMMER 2008 JUNE 11th 18.00_____
Name : _____________________________________________________
Surname : __________________________________________________
Address: ___________________________________________________________________
Tel : __________________________ Mobile: _____________________________________
E-mail: ________________________________________________________(please write very clearly)
Date of Birth: _______________ I.D. Card no. : ________________________
School/Profession:__________________________________
Current/previous courses in Italian? __________________________________
Once the courses have started no refunds, for whatever reason, can be effected. Nessun rimborso è previsto per l'interruzione dei corsi dopo il loro inizio, per nessun motivo.
Send by post to above address, or visit our offices (for opening hours please check on home page), to effect payment. Cheques are to be made payable to Società Dante Alighieri.
FEES: In advance with application form. Amount as indicated in the course pages or over the phone.
DATA PROTECTION STATEMENT: The personal data submitted above will be subject to the Data Protection Act 2001 (Chapter 440 of the Laws of Malta). The SDA will retain this data for the compilation of a database for internal use. Data subjects listed in this database will be informed of any future courses.
DECLARATION: Details of the Data Protection Statement have been read to me/ I have read the Data Protection Statement and I consent to the information provided in this application being disclosed as described therein.
I declare that the information I have given on this form is accurate and complete.
____________________
FIRMAdate:___________