INSCRIPTION FORM

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First Name:
Last Name:
Address:
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Phone:
Fax:
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Name emergency contact:
Phone emergency contact:
Nationality:
Native language:
Date of birth:
Gender:	Male    Female
Smoker:	Yes    No
Allergies:	Yes    No
If yes, which:

Course:	Select Standard Course Standard-MAS Course Intensive Course Standard "Plus1" Course Standard "Plus2" Course D.E.L.E. Course Private lessons Spanish courses for groups Course for language and culture Spanish for Juniors Compact Spanish (Barcelona) Spanish Cross Cultural (Barcelona) Academic Year Special Courses (Granada) Spanish for tourism (Seville) Medical Spanish (Seville)
Destination:	Select Malaga Barcelona Madrid Granada Seville Salamanca Almuñecar Berlin Hamburg Cologne Montpellier Nice Rom London Dublin Cambridge Bournemouth Cork Dublin Galway New York Boston San Diego Miami Syney
Duration of the course, weeks:
Language:	Select Spanish Italian French German
Starting date, course:
Current language knowledge:	Select None- first time Very little Fair Good Very Good

Accommodation:	Select Family, halfboard Family, fullboard Shared student apartment Studio-Apartment Private apartment Self-catering mini-apartments Villa (Malaga) Residence Apartment with Spaniards Hotel/Hostal without accommodation
Room	Select Single room Double room Single en-suite bathroom Double en-suite bathroom none
Date of arrival:
I will arrive by:	Select plane train bus car

Pick-up service from the airport
	Arrival:	Departure:
Date:
Time:	(hh:mm)	(hh:mm)
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Office hours: 8:30h - 17:00h, Monday - Friday
Phone: +34 952 20 34 95
Fax: +34 952 29 27 59

In compliance with the spanish law 34/2002, of July 11th, on information society and electronic commerce service, presented below are the company details:l:

Language-In Study & GO, S. L., with the Spanish Tax Identification Code:
CIF B92894161 and registred address: C/ . Reino de León, 10, 29018, Málaga. Phone: 952203495