FORMULARIO DE MATRICULACIÓN

ENTRY FORM
Course
Select course date*
CHOOSE ONE*

BOOK YOUR PLACEFULL REGISTRATION

Trainee Information
First Name*
Surname*
Mobile*
e-mail address*
example@example.com

Trainee Information
First Name*
Surname*
Date of birth*

DayMonthYear
Date
Gender*
Mobile*
Nationality
Permanent address

Street

Street (line 2)

CityCountry

Postal Code
e-mail address*
Account Number:*
Account Name:
Swift Code:

Other data
Special needs?*

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Give further info about your special requirements*
Terms and Conditions
Read the Photo Consent file and accept one of the options below
Photo Consent*

I have read and I accept the Photo ConsentI have read and I do not accept the Photo Consent

Payments
Booking Fee: 200,00 €

Balance of Payment: 880,00 €

Early Bird Fee: 1080,00 €

Course Fee: 1200,00 €
Bank Transfer
Course Fee
Bank: Caja de Ahorros y P. de Barcelona, La Caixa

International Bank Account Number (IBAN): ES89 2100 7978 9802 0005 5667

Swift Code: CAIXESBBXXX

Account Name: CELTA Asturias

Include Name and Surname and course date

Registration will only be confirmed once the proof of payment is received.
Forma de pago

TransferenciaIngresoTarjeta de credito
Fecha de pago

DayMonthYear
Date
Enclose proof of payment

Select File

Cancelarof
Credit Card

To pay by card select the fee

BOOKING FEE€200.00

BALANCE OF PAYMENT€880.00

EARLY BIRD FEE€1,080.00

STANDARD FEE€1,200.00

Total €0.00

Detalles de Tarjeta de Crédito
Nombre	Apellido
Número de tarjeta de crédito	Security Code
Expiración Tarjeta

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