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Spanish Courses - Registration form

*Surname     
*Name  
Sex   M F
*Address  
*City  
*Zip Code  
*Nationality  
*Passport Number  
*Phone  
Mobile Phone  
*E-mail  
Date of Birth   / /
Ocupation  
Phone Number (Work)  
*Country  
Fax  
Contact telephone number in case of EMERGENCY
Adress and phone number in Barcelona
 
COURSE SELECTED
Type of course  
Hours/ day (Just private lessons)  
Start Date   / /
Finish Date   / /
Number of Weeks  
NOTE/COMMENTS
SPANISH LEVEL
   
Beginner
Elementary
Intermediate
Advance
Proficiency
   
HOW DID YOU HEAR ABOUT US? :
   
Friend
Internet
Google
Travel agency
Ads
Others:
     
ACCOMMODATION
FAMILY
Type of room  
Start Date   / /
Finish Date   / /
Number of Weeks  
¿Do you Smoke?    
   
YES
NO
Do you mind a family smoke?
   
YES
NO
Do you mind pets?
    YES
NO
Is there anything else we need to know? (diets, allergies, medical problems,...)
     
SHARED APARTMENT
Type of room  
Start Date   / /
Finish Date   / /
Number of Weeks  
     
STUDENT RESIDENCE (Only in Summer)
Type of room  
Start Date   / /
Finish Date   / /
Number of Weeks  
     
NOTE/COMMENTS
     
PICK UP SERVICE
ARRIVAL    
Date   / /
Arrival Time   :
Flight Number  
Airline  
Coming from  
     
DEPARTURE    
Date   / /
Departure time   :
     
PAYMENT    
To confirm your booking you've to pay a deposit of 200€ deductable from the total cost. The rest must be paid at least two weeks before your arrival.
     
     
HOW TO PAY
CASH
 

BANK TRANSFER.

 

Bank account details:

Pylmon Languages s.l.

Bank: La Caixa

Account nº: 2100 - 2878 - 66 - 0200714710

IBAN: ES77 2100 2878 6602 0071 4710

BIC code (SWIFT): CAIXESBBXXX

Address: Av.Diagonal, 431 bis - 08036 Barcelona

Please fax us a copy of the bank transfer whit your name. FAX (+34)933178192 (All bancks charges are paid by the sender)

 

CREDIT CARD , Only VISA, MASTERCARD or AMERICAN EXPRESS (We can't accept other credit cards)

 
* I agree with all the Pylmon Languages Conditions