Transcript Private Lessons (min. 16hrs) - Italian Institute of Culture

Istituto Italiano di Cultura
Pretoria
STUDENT REGISTRATION FORM
PRIVATE TUITION
[Please complete the form in block letters]
Title:
Surname:
First name(s):
Home Address:
Work Address:
Profession:
Date of Birth (d/m/y):
Tel (h):
Cell:
Where did you hear
about the Istituto
Italiano di Cultura?
Company name:
Nationality:
Tel (w):
e-mail:
 teacher
 friend
 cultural events
 university
Would you like to receive information on
cultural events organised by the IIC ?
 internet
 ex- student
 newspaper
 italian club
 employer
 embassy
 school
 other
 Yes
 No
 business
 pleasure
 studies
 of Italian origin
 other (specify):
PLEASE COMPLETE THE FOLLOWING
Are you a first-time student at the
 Yes
 No
IIC?
Course:  16 hrs
 16 hrs renewable
How long would you like the lesson to be:  1hr  1h30  2h00
How many times a week would you like to attend:  once a week  twice a week
Which days would suite you?
Monday
 from
to
Roster Tuesday
 from
to
Wednesday
 from
to
Thursday
 from
to
Why did you decide to learn Italian?
Istituto Italiano di Cultura – Pretoria
803 George Avenue, Arcadia 0083
tel: +27 12 342 0010 – fax: +27 12 342 0057
e-mail: [email protected] – web: www.iicpretoria.esteri.it
Istituto Italiano di Cultura
Pretoria
FOR OFFICE USE ONLY
Tariff details
Tuition
Amici dell’IIC membership fee
TOTAL:
Date & Receipt No.
Type of Payment
 Cash
 Cheque
 EFT
Received by:
TERMS & CONDITIONS
1. The Istituto Italiano di Cultura reserves the right to reject applications from students that have a bad record.
2. Fees are payable in advance at the time of registration.
3. Payment can be made in cash, by cheque or bank transfer. Proof of payment must be submitted to the IIC
administration office one week before courses commence. Students will not be permitted to attend class until
payment is received.
4. Once payment has been made, no refund will be granted for partial, discontinued, interrupted or nonattendance of a course. All courses are NON-REFUNDABLE!
5. The signatory hereto indemnifies the Istituto Italiano di Cultura against liability of whatsoever nature and
howsoever arising for loss or damage to property, injury or death while on the premises of the Istituto Italiano di
Cultura in Pretoria.
6. The sixteen hour session must be completed within 2 months of registration. Hereafter, classes will no longer
be given even if the total 16 hours were not taught. The Istituto Italiano di Cultura is not liable for any
reimbursement.
7. On completion of the 16hrs students have the option to renew for a further 16 hours. These hours need to be
paid in full before classes recommence and need to be complete according to point 6 of the terms and
conditions.
8. In the event of cancellation, the student must send a notice via e-mail or fax to both the Administrative office of
the IIC ( [email protected] ) and the teacher (personal e-mail, fax or cell phone) at least 24
hours prior to cancellation. Failing to do so will result in a forfeit of the lesson. Students may not cancel more
than four classes per 16 hour session.
9. The Istituto Italiano di Cultura reserves the right to amend the prices for courses offered should there be a need.
10. Students are requested to park outside the IIC premises. A guard is on duty to ensure the safety of vehicles.
I the undersigned have read and understood the terms and conditions governing membership of the Istituto Italiano
di Cultura and hereby accept the terms and conditions as set out above.
Signature:
Place:
Date:
Stamp of the IIC:
Istituto Italiano di Cultura – Pretoria
803 George Avenue, Arcadia 0083
tel: +27 12 342 0010 – fax: +27 12 342 0057
e-mail: [email protected] – web: www.iicpretoria.esteri.it
Istituto Italiano di Cultura
Pretoria
BANKING DETAILS
ISTITUTO ITALIANO DI CULTURA
Bank: Standard Bank
Branch Code: 010845
Branch: Hillcrest
Account Number: 011 234 407
Please use your name and surname as beneficiary reference.
NOTICE
Once payment has been effected, please e-mail proof of payment to:
[email protected]
Only once proof of payment has been received will your course registration be validated.
Istituto Italiano di Cultura – Pretoria
803 George Avenue, Arcadia 0083
tel: +27 12 342 0010 – fax: +27 12 342 0057
e-mail: [email protected] – web: www.iicpretoria.esteri.it