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1. INSTITUTO HEMINGWAY NEW BOOKING
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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? :
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Telephone in case of emergency (name of the person and type of relation) :
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INSTITUTO HEMINGWAY S.L. | C/ Bailén nº 5, 2º dcha. - 48003 BILBAO (SPAIN) | +34 944 167 901 - info@institutohemingway.com
2. INSTITUTO HEMINGWAY NEW BOOKING
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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 : ..............................................................................................................
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_______________________________________________________________________________________________________________
INSTITUTO HEMINGWAY S.L. | C/ Bailén nº 5, 2º dcha. - 48003 BILBAO (SPAIN) | +34 944 167 901 - info@institutohemingway.com
3. INSTITUTO HEMINGWAY NEW BOOKING
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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 : .........................................................................................................................
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_______________________________________________________________________________________________________________
INSTITUTO HEMINGWAY S.L. | C/ Bailén nº 5, 2º dcha. - 48003 BILBAO (SPAIN) | +34 944 167 901 - info@institutohemingway.com
4. INSTITUTO HEMINGWAY NEW BOOKING
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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).
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_______________________________________________________________________________________________________________
INSTITUTO HEMINGWAY S.L. | C/ Bailén nº 5, 2º dcha. - 48003 BILBAO (SPAIN) | +34 944 167 901 - info@institutohemingway.com