Istituto Italiano di Cultura
Pretoria
STUDENT REGISTRATION FORM
I LOVE ITALY COURSES (16hrs)
[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:  I Love Italy
Why did you decide to learn Italian?
Roster
Classes are held from Monday to Thursday – NO CLASSES ON FRIDAY
Monday
Tuesday
 Morning from
to
Wednesday
 Afternoon from
to
Thursday
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
University student discount 20%
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 Istituto Italiano di Cultura reserves the right to cancel a course in the event that the registration quota is not
met. In such an eventuality, the students will be transferred to another class if available or be allowed to follow
the private classes offered by the IIC.
7. The Istituto Italiano di Cultura reserves the right to amend the prices for courses offered should there be a need
or should there be an insufficient number of students registered for the course.
8. 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