Società Dante Alighieri
134,Old Bakery Street, Valletta VLT1457 - Tel. 21 238 408 - 79 238408   email:info@dantemalta.org   

APPLICATION FORM - MODULO D’ISCRIZIONE 

Course: _____________________________________

Name : _____________________________________________________

Surname : __________________________________________________

Address: ___________________________________________________________________

Tel : __________________________ Mobile: _____________________________________

E-mail: ________________________________________________________(please write very clearly)

E-mail: (parents) ________________________________________________(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.

____________________
FIRMA (18 years & over)

date:___________