S.H.Y. - Italia CENTRO di TORINO
Via Colle di Cadibona 6 - 10024 - Moncalieri (TO)
tel. 0039/011/6968213 - fax 0039/011/6969926
NON INOLTRARE VIA E-MAIL (SPEDIRE VIA FAX O POSTA)
NE PAS ENVOYER PAR E-MAIL (ENVOYER PAR FAX OU POSTE)
DO NOT RETURN BY E-MAIL (SEND BY FAX OR POST)
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....................