ITALIAN-EMBASSY-CULTURAL-CENTRE

Document Sample
ITALIAN-EMBASSY-CULTURAL-CENTRE Powered By Docstoc
					                                                          ITALIAN EMBASSY CULTURAL CENTRE
                                                                   50-E, CHANDRAGUPTA MARG
                                                                 CHANAKYAPURI, NEW DELHI-110021

                                                                  ITALIAN LANGUAGE COURSES
                                                                            AUTUMN SESSION 2009
                                                                            APPLICATION FORM
(Tick appropriate course and appropriate timing)
A1 □ 08.00 - 09.30        □ 09.45 - 11.15      □ 16.00 - 17.30 □ 17.45 - 19.15    □ WEEKEND*
A1b □ 15.00 - 17.00 (Mon & Wed) □ 17.15 - 19.15 (Mon & Wed)
A2 □ 08.00 - 09.30         □ 09.45 - 11.15     □ 11.30 - 13.00  □ WEEKEND*
B1 □ 09.45 - 11.45        □ WEEKEND*           *WEEKEND : Saturday and Sunday 09.00 - 12.30
B2 □ 08.00 - 09.30         B2b □ 17.15 - 19.15 (Mon & Wed)
-----------------------------------------------------------------------------------------------------

PLEASE WRITE IN BLOCK LETTERS

Name:                                                                                Surname:

Place and date of birth:

Profession:

Address:
(Attach proof of residence in Delhi)

E-mail:

Telephone: (Office)                                                       (Residence)
Cell Phone No:

Reasons for learning Italian (attach additional sheets if necessary):


DECLARATION: I will abide by the rules and regulations of the Italian Embassy Cultural Centre.

Date:                                                                     Signature:


For office use: Fee Receipt No:                                           date:

- - - - - cut here - - - - - - - - - - - - - - - - - - - - - - - - cut here - - - - - - - - - - - - - - - - - - - - - - - - cut here - - - - - - -
                                      ITALIAN EMBASSY CULTURAL CENTRE
                                         50-E, CHANDRAGUPTA MARG
                                       CHANAKYAPURI, NEW DELHI-110021
                                     Italian Language Courses Autumn Session 2009

 Affix recent passport               Name:
   size photograph
                                     Address:

                                     Course:               Fee Receipt No:
                                                                                                              www.iicnewdelhi@esteri.it
                                     To be shown for gaining access to the Centre

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:21
posted:3/3/2010
language:English
pages:1
Description: ITALIAN-EMBASSY-CULTURAL-CENTRE