Personal information

   Surname   

Sex

   First name Nationality
   Date of birth

Profession/studies
   Address

Phone

   Postal code

Mobile

   Town

Fax
   Country

e-mail

   Level of Spanish
   How did you hear about us?  

Course

  City
  From      To  Number of weeks
Intensive 15 (Only Alicante, Granada)
Intensive 20 (Only Madrid, Barcelona, Valencia, Sevilla)
Intensive 25 (Only Madrid, Alicante, Granada, Valencia)
Intensive 30 (Only Alicante, Granada, Barcelona, Sevilla)
Long term course
Intensive 25    (Only Madrid)
Intensiv plus
One-to-one     Hours per week    Topics to be handled 
Standard 6  (Only Madrid)
DELE 20
DELE 30
Spanish for teachers
Combined courses
         

Accommodation

Spanish family

Shared flat

Apartment

 
Pension

 
Hotel

 
I’m coming with
Accommodation not required

Miscellaneous

  Transfer from the airport
  Yes    No
  Day
    Time  
  Flight n°
    From  
  Insurance  
  I want Contacto to organize a travel, health and accident insurance for me 
I will take out my own insurance
Cancellation insurance (3% of the total cost)
  

Remarks

 

Mode of payment

Bank transfer to Academia Contacto.  Bank: Caja Madrid.  Pza Celenque 2, 28013 Madrid . 
IBAN: ES 79 2038 0603 21 6006416975
SWIFT (BIC): CAHMESMMXXX

Credit card  
  Card holder
  Number
  Expiry date 
  In case you don’t want to send your bank details per internet, you can print this registration form and return it to us by fax: ++ 34 913 66 16 22
Deposit  150 Euros 
Total amount

I have read the general conditions and accept them.