Personal Details Name of Course: and number of weeks How did
Anuncio
Please send the Enrolment Form to AIL Madrid Personal Details Family Name: First Name(s): Home Address: Telephone: Date of Birth: Email: ID/ Passport No. Nationality: Emergency Contact Details Family Name: First Name(s): Relationship: Telephone: How did you hear about us? Search Engine: Former AIL Madrid Student Advertisement (please specify): __________________________ Google Yahoo Agent (please specify): _________________________________ Other (please specify): ____________________ Other (please specify): _________________________________ Name of Course: and number of weeks Accommodation: Spanish host family Individual Double room* Shared flat Individual Double room* Student residence Individual Double room* Hotel 3 4 5 I don’t need it * Double rooms are only available to students on a group booking. Please specify the person with whom you wish to share: ____________________________________________________________________ Arrival date: _________________________________________ Departure date: _________________________________________ Other Services Airport transfer Arrival only - 75€ Arrival and departure - 125€ Medical Insurance: Yes No Please consult AIL Madrid for more details Confirmation: I have read and accepted AIL Madrid’s terms and conditions. Signature: Date: Academia Internacional de Lenguas Madrid S.L - C.I.F. B84717180 - www.ailmadrid.com Inscrita en el Registro Mercantil de Madrid, Tomo 22.813, Libro 0, Folio 11, Sección 8ª y Hoja número M-408343
