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


ACCEPT

I confirm and accept the Terms and Conditions published on the website of ocidiomes. See conditions and legal data.

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

AUTHORISATION FOR INTERNAL USE OF THE FOLLOWING DATA **
YES, I authorize OCIDIOMES

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