Adult Course Registration Form

Adult Course Registration Form

Personal Details

Lucas
Digne
12/10/1990
lucasdigne@gmail.com
Please provide a mobile number with international code (+353 86 12345678)

Emergency Contact Information

marthadigne@gmail.com

Course Details

Academic Year Programme = 25 weeks

Accommodation Details

*Only available for two students booking together **Couples Only

Flight Details

Aer Lingus
EI 104 from Milan
Arrival Time
24 Hour Format (Arrival Time = 17.15)
Aer Lingus
EI 106 to Milan
Departure Time
24 Hour Format (Departure Time = 13.30)

Special Requirements

Do you have a special learning requirement? *
I declare that I have read and accept the terms and conditions of registration at Atlantic Language Galway and Dublin. *
Please note that your registration is ONLY PROVISIONAL. An Atlantic Language team member will confirm your registration within two working days of receiving your completed form.