Name:
Surname:
Passport-#:
Sex:
Age:
Profession:
Street:
Postcode:
City:
Country:
E-Mail:
Phone 1:
Fax:
Phone 2:

How did you learn about our school ?
University / School	Embassy / Consulate
Friends	Spanish tourist office
Internet	Advertisement
Other

How would you assess your knowledge of Spanish ?
None	Poor	Fair	Good	Very Good

I WISH TO ENROLL IN THE FOLLOWING COURSE(S):

From to For weeks

Course A	Course B1	CourseB2
CourseC Plus 1	CourseC Plus 2	Long Term
Course D Private classes Lessons per week

Course E - Preparation Course D.E.L.E. exam
May - Nivel de examen	Intermedio	Superior
Nov. - Nivel de examen	Intermedio	Superior

Combination Course F	Córdoba-Málaga	Córdoba-Granada
20 Lessons/ Weeks

Additional Private Classes Lessons per week Course "ERASMUS"

For the duration of the course please book:
From to
Single Room	Double Room

IN:

A Private Accommodation

B Private accommodation / half board with a family

B Private accommodation and full board with a family

C Hotel ****/Breakfast

D Hotel ***/Breakfast

E Hotel **/Breakfast

F Hostel

G Apartment: People

People without course No lodgings

Deposit of € by:
Money Order to Centro de Idiomas LARCOS, Banco Santander Central Hispano, Córdoba, BIC: BSCHESMM, IBAN: ES39 0049 1874 0724 1010 2657, bank code Nº 0049 187407, account Nº 2410102657
International postal order to the school address
Credit card	Visa	MC	Amex
Card-No:		Valid thru:
I have read the Terms of Trade and agree to aside by them.