PARTICIPANT DETAILS

    LAST NAME *

    NAME *

    DNI/NIE/PASSPORT

    DATE OF BIRTH (dd/mm/aaaa) *

    SEX

    ADDRESS

    CP

    LOCATION

    EMAIL

    HOME PHONE

    MOBILE PHONE 1

    MOBILE PHONE 2

    MEDICAL HISTORY/ALLERGIES

    HOW DID YOU HEAR ABOUT OCIDIOMES?

    CONSULTOR

    SCHOOL (WHERE THE STUDENT STUDIES)

    COURSA

    DATA TO BE FILLED IN ONLY FOR FOREIGN COURSES

    COUNTRY

    CITY

    Nº WEEKS

    DATE OF DEPARTURE (dd/mm/aa)

    DATE OF ARRIVAL (dd/mm/aa)

    INSURANCE (OPTIONAL FOR ADULTS)

    ACCOMMODATION

    ROOM

    TYPE OF COURSE (ADULTS)

    REMARKS

    Documentation to be presented:
    - Photocopy or passport or DNI
    - Photo Card
    - European Health Insurance Card

    DATA TO BE FILLED IN ONLY FOR FACE-TO-FACE CLASSES AND CAMPS

    PROGRAM NAME

    START DATE (dd/mm/aa)

    END DATE (dd/mm/aa)

    START TIME (hh:mm)

    END TIME (hh:mm)

    LANGUAGE (fill in only in-person classes)

    LEVEL (fill in only students in face-to-face classes)

    DAY OF THE WEEK

    REMARKS

    PAYMENT METHODS

    TOTAL COURSE FEE

    REMARKS

    MONTHLY AMOUNT OF THE COURSE (presential classes only)

    METHOD OF PAYMENT

    NUMBER IBAN FOR THE DOMICILED RECEIPT

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    I accept direct debit if I want to pay according to this procedure.

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