Inscription form


Personal Details
Surnames*
First name*
Passport n.*
Date of birth*
Nationality*
Gender*
FemaleMale
Address*
Post Code*
Location*
Province*
Country*
Telephone*
E-mail*
Profession
Person of contact in case of an emergency: Full name and telephone number*

Name
Telephone*
Address in Spain during your course (if no accommodation with A+ Language Schools)*


Course Details
Course Name*
Start Date*
Finish Date*
Nº Weeks*
Language Level
A1A2B1B2C1C2

How did you hear about A+ Language Schools for the first time?

Accommodation
Accommodation*
YesNo
Select accommodation
¿Private bathroom? (at an additional cost)
YesNo
Other/Extra wishes (we will do all we can to comply with your preferences although we cannot guarantee them):
Do you smoke?*
YesNo
Would you mind sharing accommodation with smokers?
YesNo
Would you mind sharing accommodation with pets (cats, dogs,...)?
YesNo
Do you have any special dietary conditions?
YesNo
Details
Do you have any allergies or special medical conditions?
YesNo
Details

Transfers (at an additional cost)
Transfer:
YesNo
One way or Return:
One wayReturn
Date of arrival in Pamplona:
Time of arrival in Pamplona:
Place of arrival in Pamplona:
AirportBus StationTrain Station

Flight nº
Date of departure from Pamplona:
Time of departure from Pamplona:
Place of departure from Pamplona:
AirportBus StationTrain Station

Flight nº
Time of service: 8.00 a 20.00 horas (outside of this time there will be an extra charge of 15€)

Health centre and medical insurance
It is your responsibility to take out insurance to provide protection in case of illness, accident...
We recommend Europ Assistance insurance,
Would you like to book Europ Assistance insurance?
YesNo

Payment Details
I will pay by:
CashBank TransferCredit CardVisaMaster CardAmerican Express
Credit Card Details
Name of card holder:
Card number:
Security nº:
Expiry date month:
Expiry date year:
Bank charges are the responsibility of the client.

Before Applying for a course, please read carefully general conditions.
I have read the General Conditions and I agree to abide by them.
Al seleccionar esta casilla, reconozco que he leído y acepto las Condiciones Generales.

Payment details

Educational Services Pamplona

Account Number: 2100 5153 91 0200022965

Swift code: CAIXESBBXXX

IBAN: ES02 2100 5153 9102 0002 2965

Bank: La Caixa Dirección: C./ San Cristóbal, 31015 Pamplona, Navarra, Spain