ICCM STUDENT REGISTRATION FORM

Student Registration Form 10 2-hours lessons: $285

Small Groups - Fast Pace - Only Native Italian Speaking Instructors.
ADULT
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student E-mail*
Mobile Number*

Area CodePhone Number
Work Number

Area CodePhone Number
Company
Type of class of interest:*

private lessongroup class
Years of Study*
Current Level - Self Assessment*

beginner 1 (approximately 20h)beginner 2 (approximately 40h)beginner 3 (approximately 60h)intermediate 1intermediate 2intermediate 3advanced 1advanced 2advanced 3
Our instructors will verify your knowledge level during a brief phone interview and will confirm your assessment or suggest a different level so you can get a better experience and have faster results.
Availability: (please select all that applies)*

Tuesday morningWednesday morningThursday morningFriday morningSaturday MorningTuesday afternoon/eveningWednesday afternoon/eveningThursday afternoon/eveningFriday afternoon/eveningSaturday afternoon/evening
At what time at the earliest are you able to attend class*

9:30 AM10:00 AM10:30 AM11:00 AM3:00 PM3:30 PM5:00 PM5:30 PM
What are you looking for in a class? *
Language Courses*

beginner 1beginner 2beginner 3intermediate 1intermediate 2intermediate 3advanced 1advanced 2advanced 3
Additional Comments
Should be Empty:

Student Registration Form 10 2-hours lessons: $285