This Enrollment Form can be printed from the Internet, filled out and mailed or faxed to us.  Payment must be received at least 24 hours PRIOR to the beginning of class.

First Name: ______________________  Last Name: ____________________________
Address:  __________________________________________________________
City:  ______________________________ State: _______ Zip: _______________
Home Phone: _______________________        Work Phone:  _______________________        Cell Phone:  _______________________
E-mail:     _________________________________           Occupation: ____________________
New student: ____           Returning Student: ____
______ Please check if you want to be removed from our email mailing list.

How did you hear about ItaLingua? (circle which applies)
Internet (please identify the search engine used)______________  Yellow Pages__  Chronicle__  East Bay Express__  SF Weekly__  KQED__  Friends__ Other ______________________

Hobbies/Interests________________________________________

I would like to register for:          (  ) San Francisco            (  ) Berkeley

Class: _______________________________    Day: _______________  Time:_____________

Enclosed is  $________________________    Form of payment:    (   ) Check (   ) Cash (   ) Credit Card
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I would like to use:          (  ) VISA            (  ) MasterCard

Card Number: _______________________________    Expiry: _______________  CVC (Code on back):_____________
Does the card bill address match the address above?          (  ) Yes            (  ) No
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Enrollment Policy
1.  Students may enroll in person during normal business hours.  Alternatively, students may mail, or FAX,  this enrollment form with a check to 870 Market, Suite 450, San Francisco, CA  94102.  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
1. If Italingua cancels a class, students can transfer to a different class or receive a full refund.
2. Students wishing to cancel their course registation must do so 24 hours before the first class in order to receive either a full refund or credit. No refunds or credits will be allowed, for any reason, after the first class.

Approvals for transfers will be based on course and space availability.

Signature: ___________________________________________Date:__________________
Note: In order to have your Italian language proficiency assessed, please phone the office (415-362-6025) between 2:30-6:00pm and ask for Francesca Gaspari.
Berkeley Enrollment: Students enrolling in our Berkeley classes may send this enrollment form together with a check to:  Italingua Institute, 870 Market Street Suite 450, San Francisco, CA   94102.