Enrolment Form for Distance Learning

In order to guarantee an appropriate service and to be able to provide you with a final certificate we request that you complete this form. Please complete all the compulsory fields *).

If the client and student are not the same person please fill in the information regarding the client at the bottom of the form in order to set up the appropriate invoice.

First and last name of the student*

Date of birth of the student*

Sex Male Female

Country*

City

Zip-postcode

Street and number

Phone

E-mail address 1*

Repeat e-mail address 1*

Alternative e-mail address

My current level of Spanish*

I choose the following course*

I choose the following course

My starting date

My objectives

I found out about IEMA

Remarks

I am interested in a “on-site” course in Ávila, Spain.

I am interested in a blended learning/integrated learning programme.

If the student is a minor: Information on the legal guardian of minor student

First and last name

Date of birth

Country

City

Zip code

Street, nº

Phone

E-mail address 1

Repeat e-mail address 1

Alternative e-mail address

Remarks

Information of client if different from student

First name / last name / name of company

Phone

E-mail address 1

Repeat e-mail address 1

Alternative e-mail address

Further information for invoicing

Remarks

I have read and understood the terms and conditions and agree with them. I agree with the information concerning privacy and data protection (Conditions)*

Any questions? - Or would you like to enter the forum?

¿Tienes preguntas? - ¿O quieres participar en el foro abierto?

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