ItaLingua
870 Market Street, Suite 446 | San Francisco, CA 94102
Ph. (415) 362-6025 | Fax (415) 362-2814 | www.italingua.org | italian@italingua.org

Enrollment Form

This Enrollment Form can be printed from the Internet, filled out and mailed, emailed or faxed to us. Payment must be received PRIOR to the beginning of class.

Term:    
Class: []    
Location:     
Day:    

Contact information
First Name: ______________________  Last Name: ____________________________
Address: __________________________________________________________
City: ______________________________ State: _______ Zip: _______________
Home Phone: __________________   Work Phone: _________________   Cell: _________________
E-mail: _________________________________   Occupation: ____________________
Hobbies/Interests ________________________________________

How did you hear about ItaLingua? (check which applies)
Internet   Friends   Printed Brochure   Other (describe) ______________________
 
I'm a     New student     Returning Student

Payment
Class tuition
"Bring a Friend" $35 special discount (must be approved by the school) $_______
Tax-deductible donation to support ItaLingua $_______
Total enclosed $________________________   

Form of payment:     Check      Cash      VISA      MasterCard
Card Number: __________________________________    Expiration: ____/____ 
Does the card bill address match the address above?     Yes     No

Enrollment Policy

1. Students may enroll in person during normal business hours.  Alternatively, students may mail, email or Fax,  this enrollment form with payment to ItaLingua. Full payment must be paid by the first class.
2. Pre-registration is strongly encouraged, as we make every attempt to limit the grammar classes to 15 students and the conversational classes to 10 students.
3. We are unable to offer classes without sufficient enrollment and reserve the right to cancel or rearrange classes.
4. Non-discriminatory policy: ItaLingua admits students of any race, color, national or ethnic origin.

Please review the refund policy and sign below
If ItaLingua cancels a class, students can transfer to a different class or receive a full refund. Students who cancel their course registration before the first scheduled class may receive either a full refund or credit.
No refunds or credits will be allowed after that date for any reason.
By enrolling for any of our classes, you agree to and understand our refund policy.

Signature: ___________________________________________ Date: __________________