PRE-REGISTRATION WITH POLIEDRO

POLIEDRO

Italian Language School in Italy

Save 5% on Your Course Fees

Booking Form

Poliedro will give you a 5% discount on your program fees if you register online by using the form you will find below

Please note that ORBISLINGUA.com is not an agency. ORBISLINGUA.com just provides an online platform for an easy and direct registration with Poliedro. The registration is made directly between the student and the language school.

Within the next 48 hours after you have submitted this form, Poliedro will contact you to confirm your form has been received and to provide you with further instructions on how to formalize your registration to study at the school.

DISCOUNT apply only when using this form!

PERSONAL INFORMATION

Your First Name:
Your Last Name:
Gender:
Nationality:
Date of Birth:
Occupation:
Address:
City:

State:
Zip/Postal Code:
Country:
Home Phone:
Fax:
E-mail:
Alternative e-mail:
Emergency Contact name:
Emergency Contact Phone:

PROGRAM ATTENDING

Program (according to the choices in the school description):
Number of weeks you wish to book: Starting date of classes:
Level: Objectives:
Additional Information*:

ACCOMMODATION

Please list your type of accommodatios according to the choices in the school description:
Arrival Date for Accommodation:
Departure Date for Accommodation:

Medical Conditions:
Dietary Concerns:
Additional Information:

ARRIVAL (This information can be sent later)

Pick Up wanted Yes No

THANK YOU !