REGISTRATION FORM

Date*:

PERSONAL INFORMATION

Surname*:  

Sex*: Man Woman

Name*:      

Date of birth:     

Country*:   

Nationality*:      

Passport number*:

Address*:   

City/Town*:

Post code:         

E-mail*:      

Telephone 1*: (+ )

Telephone 2: (+ )

How did you Know INSTITUTO ATLÁNTICO INTERNACIONAL? *

Google Internet advertisement School Catalogue Another student Mailing

Others (indicate):

Current spanish level*: Beginners Intermediate Advanced Proficiency

CHOSEN SPANISH COURSE *

Intensive course

Preparation for D.E.L.E.

Spanish for managers and Spanish for business: Profession:

Spanish for non native teachers

Others:

COURSE DURATION *

Number of weeks:

Individual extra hours/week:

From:

To:

ACCOMMODATION *

Selected family: Individual room Double room

Student residence

Spanish teacher's house

Hotel / Hostel

Apartment

Shared flat

PICK UP SERVICE AT AIRPORT OR STATION *

YES NO :

Pick up place:

MEDICAL INSURANCE *

I don't have. I want to contract an Spanish insurance

I have got a medical insurance or I will contract one from my country( in this case, make sure that your insurance will cover you in Spain )

SPECIAL CONDITIONS

Have you got any disability or need special access conditions?

Are you allergic?

Are you following any medical treatment we should know?

Are you on a diet or can't eat any kind of food?

If you have answered yes to some of these questions, you must enclose a writing giving details about your special conditions and the treatment to follow