New Booking Bilbao Instituto Hemingway

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New Booking Bilbao Instituto Hemingway

  1. 1. INSTITUTO HEMINGWAY NEW BOOKING ____________________________________________________________________________________________________________________ NEW BOOKING E-mail : info@institutohemingway.com Fax : +34 94 416 57 48 I understand that by sending this form I accept all Instituto Hemingway conditions PERSONAL DATA Student’s Name : ............................................................................................................. Male Female Date of Birth : ....... / ....... / ........... Age : ............. Passport Number : ..................................... Nationality : ............................................... Native Language : ..................................... Permanent address : .............................................................................................................. City : ..................................... Zip Code : ......................................... Country : ...................................................... Telephone : ........................ Fax : ......................... E-mail : .................................................. How did you hear about the INSTITUTO HEMINGWAY? : ............................................................................................................................................. ............................................................................................................................................. Telephone in case of emergency (name of the person and type of relation) : ............................................................................................................................................. ............................................................................................................................................. 1 _______________________________________________________________________________________________________________ INSTITUTO HEMINGWAY S.L. | C/ Bailén nº 5, 2º dcha. - 48003 BILBAO (SPAIN) | +34 944 167 901 - info@institutohemingway.com
  2. 2. INSTITUTO HEMINGWAY NEW BOOKING ____________________________________________________________________________________________________________________ COURSE Course starts : ....... / ....... / ........... Course ends : ....... / ....... / ........... Course Name : Principal Spanish course (20 lessons per week) Other (Please write the name of the course) : ............................................................................... Approx level of Spanish : Lowest 0 1 2 3 4 5 6 7 8 9 Highest (Please check one) HOUSING Arrival date : ....... / ....... / ........... Departure date : ....... / ....... / ........... (Please note that accommodations are available from the Sunday before the first day of the program until the Saturday after the last day of the school) Type of accommodation : Host Family Half-board (breakfast and dinner) Host Family Full board (all meals) Student dormitory Shared Flat (Please check one) Other : ............................................................................................................................ Smoker : Yes No Minds smoking : Yes No Minds animals : Yes No Special Requests : .............................................................................................................. 2 _______________________________________________________________________________________________________________ INSTITUTO HEMINGWAY S.L. | C/ Bailén nº 5, 2º dcha. - 48003 BILBAO (SPAIN) | +34 944 167 901 - info@institutohemingway.com
  3. 3. INSTITUTO HEMINGWAY NEW BOOKING ____________________________________________________________________________________________________________________ AIRPORT TRANSFER Even if you do not request an airport transfer, please inform us your flight details. Upon Arrival : Yes No (Please check one) City of arrival : ........................................................................................................ Arrival Date : ....... / ....... / ........... Airline : ............................................. Flight Number : ................. Time : ....... : ....... am/pm Upon Departure : Yes No (Please check one) City of departure : ................................................................................................... Arrival Date : ....... / ....... / ........... Airline : ............................................. Flight Number : ................. Time : ....... : ....... am/pm AUTHORIZATION FOR CHARGES Amount authorized : ................. Euro or US $ Visa/MasterCard number : ......... / ......... / ......... / ........................................ Expiration date : ....... / ........ Cardholder’s Name : ............................................................................................................. I understand that the amount authorized to charge in US dollars will be converted into Euros at the exchange rate of the day of the charge. I understand that by sending this form I accept all of Instituto Hemingway´s conditions. To certify that the information given above is true, I hereby sign this document. Cardholder’s passport number: .............................................................................................. Signature : Date : ....... / ....... / ........... Comments : ......................................................................................................................... 3 _______________________________________________________________________________________________________________ INSTITUTO HEMINGWAY S.L. | C/ Bailén nº 5, 2º dcha. - 48003 BILBAO (SPAIN) | +34 944 167 901 - info@institutohemingway.com
  4. 4. INSTITUTO HEMINGWAY NEW BOOKING ____________________________________________________________________________________________________________________ BANK TRANSFER Bank Name : BANCO SABADELL ATLANTICO Account Name : INSTITUTO HEMINGWAY Account Number : 0081 7511 86 0001035412 IBAN ES97 BIC – SWIFT: BSABESBB Postal address of the bank : Bidebarrieta 5, 48003 Bilbao (Spain) PRIVACY POLICY The personal details that are supplied to us will go on to form part of an automated file that is the property of Instituto Hemingway. The user authorizes the treatment of their personal details that they have voluntarily submitted in order to be able to provide the entrusted services, and gives their express consent to receive information that publicises our new services and offers, by any means, including email. Likewise the user gives their consent for Instituto Hemingway to transfer their details to associates and collaborating companies, such as with those other businesses or physical or legal persons agreements are arranged to provide a better delivery of service, respecting the Spanish legislation about data protection. In any case, you are able to exercise your access, correction, cancellation or opposition of agreement rights according to the 15/1999 Act of Personal Data Protection, personally directing your request by email to info@institutohemingway.com or via a written request to: Instituto Hemingway., C/Bailén 5-2 dcha 48003, Bilbao (Spain). 4 _______________________________________________________________________________________________________________ INSTITUTO HEMINGWAY S.L. | C/ Bailén nº 5, 2º dcha. - 48003 BILBAO (SPAIN) | +34 944 167 901 - info@institutohemingway.com

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