Personal Details

Family name *
First name *
Id-Passport *
Gender: Male Female *

(ej. 10/10/2006)

Date of birth *
Nationality *
Home Address
Post code
Location
Province
Country
Profession
Telephone
E-mail *
Person to contact in case of emergency: full name and telephone
Address in Spain during your course (if no accommodation with Pamplona Learning Spanish Institute):

Course Details

Course Name *
Start Date *
Finish Date *
Nº Weeks *
Language level A1. Elementary A2. Pre-Intermediate B1. Intermediate B2. Upper-Intermediate C1. Advanced C2. Superior
Course code

How did you hear about Pamplona Learning Spanish Institute for the first time?

Please specify who, which or where of the option you have chosen:

Health centre and medical insurance

It is your responsability 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? (45€ per 4 weeks or less) YES NO

Payment Details

I will pay by: Cash Bank transfer Credit card VisaMaster Card

Credit Card Details

Name of card holder
Card number
Security nº
Expiry date:
Month
Año

Bank charges are the responsibility of the client.

PAMPLONA LEARNING SPANISH INSTITUTE bank details

Account number: 2054 0114 37 9142193654

Switf code:CANVES2P

IBAN: ES1520540114379142193654

Bank: CAJA NAVARRA

Address: C/ REAL, 48 - 31110 NOAIN (NAVARRA)

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