MB Scambi Culturali - FORMAZIONE ALL'ESTERO Via San Biagio, 13 - 35121 Padova - ITALIA Tel. +39 049 8755297 - Fax +39 049 664186 E-mail: incoming@mbscambi.com Sito: www.mbscambi.com/incoming

CONTACTS › Information request for MB International Summer Camp Children and Teens *mandatory fields

NAME * FAMILY NAME * ADDRESS * CITY * POSTAL CODE * COUNTRY * NATIONALITY * TELEPHONE * E-MAIL * Camp Programme Choose Children Camp; Teens Programme Young Adults Programme Language Programme Choose English Language Programme Italian Language Programme * Information»   Starting Dates Choose June 28th 2009 July 5th 2009 July 12th 2009 July 19th 2009 July 26th 2009 Any / All * Length of stay in weeks Choose----------------------------------------------- 1 week 2 weeks 3 weeks 4 weeks 5 weeks Language Level Specify you language level A1 - Beginner A2 - Elementary B1 - Lower Intermediate B2 - Intermediate C1 - Higher Intermediate C2 - Advanced Interest for the course Choose One or more (click+ctrl for multiselection)----- Improve language level Holiday Practice sport Specify your education Age * Have you studied Italian before Choose----------- Yes No Have you been to Italy before Choose------- Yes No Comments I give authorization to treat my personal data for the purpose of requesting information and according to the Italian Law 196/03 Please call me Choose-------------------- within 10 days within 20 days

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