[01]Personal Details

1.01

 

Surname

1.02

 

First Name

1.03

 

Sex

 Male

 Female

1.04

 

Address

1.05

 

Post (Zip-) Code

1.06

 

Town

1.07

 

Country

1.08

 

Phone: private

1.09

 

Work

1.10

 

Mobile

1.11

 

Fax

1.12

 

E-mail 

1.13

 

Date of Birth

1.14

 

Passport Nº 

1.15

 

Nationality

1.16

 

Profession/Company  

1.17

 

I heard about IEMA from

 

 

 

 

 

[02]Language Skills

2.01

 

My level of Spanish

 none / beginner

 intermediate

 advanced

 

 

2.02

 

My level of Spanish according to European criteria

A1

A2

B1

B2

C1

C2

2.03

 

Name of my Spanish school

2.04

 

I have been studying Spanish from

2.05

 

Until

2.06

 

Number of lessons / week

2.07

 

I speak the following languages

 

 

 

 

 

 

 

 

 

[03]Travel Details

3.01

 

Arrival date in Ávila

3.02

 

Departure date

3.03

 

Flying to

 Madrid

 

 

 

 Valladolid

 

 

 

3.04

 

Arrival date (flight)

3.05

 

Arrival time

3.06

 

Flight number 

3.07

 

Company

3.08

 

City of last stop-over

3.09

 

Departure date (of flight, after my course)

3.10

 

Departure time

 

 

 

 

 

 

 

 

 

[04]Details In Case Of Emergency

4.01

 

Name of Contact Person

4.02

 

Phone (private)

4.03

 

Phone (work)

4.04

 

Phone (mobile)

4.05

 

Fax

4.06

 

E-mail

4.07

 

Remarks

 

 

 

 

 

 

 

 

.

4.08   I have taken out a medical insurance
Yes
No
4.09   Number of my insurance card / policy
4.10   I request IEMA contracting for me a medical insurance 
Yes
No

 

 

 

 

 

General Spanish Language Courses

 

[05]Mini-Group Course (3-8 Students)

 5.01

 

 

 5.02

 

I book

weeks

 5.03

 

Starting date

 

 

 

 

 

 

 

 

 

[06]“The Course for 2” 

6.01

 

I book

weeks

6.02

 

Starting date

6.03

 

 

 

6.04

 

Second person information

 

6.05

 

Surname

6.06

 

Name

 

 

 

 

 

 

 

 

 

[07]Private Lessons

 7.01

 

I book

2

4

6

8

daily lessons of 45 minutes

 7.02

 

I book

90 min. private lessons in addition to my group course

 7.03

 

Starting date

 

 

 

 

 

 

 

 

 

[08]Mini-Group Course “Special” (3-8 Students + 2 Extra Private Lessons of 90 Mins./Week)

8.01

 

I book

weeks

8.02

 

Starting date

 

 

 

 

 

 

 

 

 

Special Courses

 

[09]Courses for Spanish Teachers

9.01 ¡A QUE NO SABES!
    Required dates
9.02 ¿ESPAÑA ES DIFERENTE?
    Required dates
9.03 ¡A HABLAR!
    Required dates
9.04 ¡RECICLATE!
    Required dates

 

 

 

 

 

[10]Preparation DELE

10.01

Option A (private)

I require sessions of 90 mins. / week

10.02

Option B (groupe)

Spanish level  

 

 

 

 

 

[11]Spanish for Business

11.01

Private I require lessons of 90 mins. / week

11.02

Groupe Dates of programme

11.03

How to negotiate successfully in Spanish Required dates

 

 

 

 

 

[12]¡Con soltura! - Conversation course

12.01

Dates of programme

 

 

 

 

 

[13]Other Programmes

13.01

Private course in Teacher´s Home

Arrival date

Departure date  

13.02

Medical Spanish Required dates

13.03

Legal Spanish Required dates

13.04

University students I require the following programme

13.05

High school I require the following programme

13.06

50+ I require the following programme

13.07

Other programmes

 

 

 

 

 

Culture Lessons

 

[14] Culture Lessons

14.01

”Hispania I”

(5 lessons / week of the courses: A, C, E, F, H)

14.02

”Hispania II”

(5 lessons / week of the courses: A, B, D, E, G)

14.03

Complete Culture Courses (8 lessons each)

14.04

A

"¡Spain is Different!"

14.05

B

Spanish Society, Politics and Economy

14.06

C

Art, History, Legends and Monuments of Ávila

14.07

D

History of Spanish Art

14.08

E

Spanish History

14.09

F

“Spain is a Party”: Spanish Cuisine and Customs

14.10

G

Spanish Songs

14.11

H

Latin-America Yesterday and Today

14.12

Masterpieces of Spanish Literature

14.13

Spanish Mysticism

 

 

 

 

 

Leisure Activities

 

[15]Leisure Activities

15.01

Conversation

(2 lessons / 90 minutes / week)

15.02

Gastronomy and Wines

I book sessions

15.03

Spanish Dance

I book classes

15.04

Sing with us! I

I book activities

15.05

Fiestas, Dinners, etc

I book activities

15.06

Sports (Volleyball, Basketball)

I book activities

15.07

Aerobics, Fitness, Gym

I book activities

15.08

Golf

I book private lessons

15.09

Sightseeing in Ávila

I book activities

15.10

¡Diviértete!

I book activities

 

 

 

 

 

Special Services

 

[16]Special Services

16.01

Cancellation Insurance

16.02

Bicycle rental

for    days

16.03

Dates

from to

16.04

 

I am interested in Excursions to

El Escorial

Segovia

Salamanca

16.05

I request Airport Transfer

16.06

A- Transfer Madrid or Valladolid   Avila –  Madrid or Valladolid

16.07

B- Transfer Madrid or Valladolid – Avila

16.08

C- Transfer Avila – Madrid or Valladolid

16.09

I wish the Final Qualified Diploma

16.10

I intend to sit the official “DELE” Examination

16.11

I intend to sit the “DIE” Examination

16.12

I wish to participate in the European Spanish Language exam

 

 

 

 

 

[17]Accommodation

17.01

Hotel

**

***

****

*****

17.02

 

Spanish Homestay with

 Spanish breakfast

 Half board

 Full board

 

17.03

I book a double room with

17.04

I wish to be the only student of my language at home

17.05

I wish to be the only foreign student at home

17.06

I have health problems or require medication (indicate)

17.07

I am a smoker

17.08

I require a non-smoking family

17.09

I require vegetarian food / 

17.10

I require a family without a dog

17.11

I require a family without a cat

17.12

I require my own lavatory

17.13

I require laundry service

 

 

 

 

 

[18]Deposit And Acceptance Of Conditions

 18.01

The Deposit of 120 Euros (132 Euros when including the cancellation insurance) was made on (date)

 18.02

in the following way

 18.03

IEMA agrees to provide the services reserved by the client in accordance with the published conditions

 18.04

I accept the conditions of the « Instituto Español Murallas de Ávila

 18.05

Remarks

18.06

Date