This Enrollment Form can be printed from the Internet, filled out and mailed, emailed or faxed to us.  Payment must be received PRIOR to the beginning of class.

First Name: ______________________  Last Name: ____________________________
Address:  __________________________________________________________
City:  ______________________________ State: _______ Zip: _______________
Home Phone: _______________________        Work Phone:  _______________________        Cell Phone:  _______________________
E-mail:     _________________________________           Occupation: ____________________
New student: ____           Returning Student: ____
______ Please check if you want to be removed from our email mailing list (Low volume, 5-6 times a year, mostly our new schedules for classes).

How did you hear about ItaLingua? (check which applies)
Internet (please identify the search engine/site)__________________  Friends__  Brochure in Store/Restaurant__  Other ______________________

Hobbies/Interests________________________________________

I would like to register for:          [   ] San Francisco            [   ] Berkeley             [   ] Marin 

Class: _______________________________    Day: _______________  Time:_____________

Enclosed is  $________________________    Form of payment:    [   ] Check [   ] Cash [   ] Credit Card
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   [   ] I would also like to make a tax-deductible contribution of $_______ to ItaLingua.
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I would like to use:          [  ] VISA            [  ] MasterCard

Card Number: __________________________________    Expiry: _______________ 
Does the card bill address match the address above?          [  ] Yes            [  ] No
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Enrollment Policy
1.  Students may enroll in person during normal business hours.  Alternatively, students may mail, email or FAX,  this enrollment form with payment to 870 Market, Suite 446, San Francisco, CA  94102.  Full payment must be paid by the first class. 
2.  Pre-registration is strongly encouraged, as we make every attempt to limit the grammar classes to 15 students and the conversational classes to 10 students.
3.  We are unable to offer classes without sufficient enrollment and reserve the right to cancel or rearrange classes.
4.  Non-discriminatory policy:  Italingua admits students of any race, color, national or ethnic origin.

Please review the refund policy and sign below
If Italingua cancels a class, students can transfer to a different class or receive a full refund. Students who cancel their course registration before the first scheduled class may receive either a full refund or credit. No refunds or credits will be allowed after that date for any reason. By enrolling for any of our classes, you agree to and understand our refund policy.

Signature: ___________________________________________Date:__________________