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 S.H.Y. - Italia CENTRO di TORINO
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 LIVELLO AVANZATO 1 del ................ (inserire la data)
 NIVEAU AVANCE 1 -  LEVEL ADVANCED 1


 COGNOME:	...............................................
 NOM/SURNAME:

 NOME: 		...............................................
 PRENOM/NAME:

 INDIRIZZO:	...............................................
 ADRESSE/ADDRESS:

 CAP/CODE: 	............CITTA'/VILLE/CITY: ................

 NAZIONE:	...............................................
 PAYS/COUNTRY:

 TELEFONO:	...............................................
 TELEPHONE:

 PROFESSIONE:	...............................................
 PROFESSION:

 DATA DI NASCITA: .............................................
 DATE DE NAISSANCE/DATE OF BIRTH:


 LINGUA DI TRADUZIONE:.........................................
 LANGUE SOUHAITEE/PREFERRED LANGUAGE:

 ALLEGARE / JOINDRE / ENCLOSE:
 - FOTOCOPIA LIVELLO 7SP (Intermedio 2)/PHOTOCOPIE NIVEAU 7SP
 (Intermediaire 2)/PHOTOCOPY OF LEVEL 7SP (Intermediate 2)
 - PROVA DI PAGAMENTO/ JUSTIFICATIF DE PAYEMENT
 PROOF OF PAYMENT

 AUDITORI / AUDITEURS / AUDITORS:
 - FOTOCOPIA ULTIMO LIVELLO EFFETTUATO
 - PAGAMENTO AL CORSO / PAYEMENT SUR PLACE / PAYMENT AT THE
 COURSE VENUE

 DATA/DATE...................FIRMA/SIGNATURE....................

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