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 Name Middle Name Last Name
Birth Date *

Month Day Year
Gender

Address

Student E-mail *
Mobile Number *

Area Code Phone Number
Work Number

Area Code Phone Number
Company
Type of class of interest: *

private lesson group class
Years of Study *
Current Level - Self Assessment *

beginner 1 (approximately 20h) beginner 2 (approximately 40h) beginner 3 (approximately 60h) intermediate 1 intermediate 2 intermediate 3 advanced 1 advanced 2 advanced 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 morning Wednesday morning Thursday morning Friday morning Saturday Morning Tuesday afternoon/evening Wednesday afternoon/evening Thursday afternoon/evening Friday afternoon/evening Saturday afternoon/evening
At what time at the earliest are you able to attend class *

9:30 AM 10:00 AM 10:30 AM 11:00 AM 3:00 PM 3:30 PM 5:00 PM 5:30 PM
What are you looking for in a class? *
Language Courses *

beginner 1 beginner 2 beginner 3 intermediate 1 intermediate 2 intermediate 3 advanced 1 advanced 2 advanced 3
Additional Comments
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Student Registration Form 10 2-hours lessons: $285