Registration on line

( Please, keep the cookies on to mantain your selected language )

Family Name

First Name

Sex	Date of Birth

Home Address

Town

Zip Code

Country

Other

Phone

Fax

E-mail

Profession

Mother Tongue

Other Languages

I hereby register for the following Art Jewellery course:

Starting date

Number of weeks

Accommodation

Kitchen

with the use of the kitchen

How many stars?

bedroom

room/s

I would like to share the room with

Do you have any experience?

How long have you done it?

Where

How did you first hear about the school Cultura Italiana?

Do you need a baby-sitter?

Do you smoke?

Do you have any allergies?

Do you have special request?

A deposit of Euro 130 is required.

I wuold like to pay by

Visa - Mastercard

In this case your enrollment will remain pending the receipt of your deposit

I read and accept the school procedures


I agree to receive from Cultura Italiana information about their courses and initiatives and authorize the use of my data only for these purposes