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

We offer you the chance to study at both centres meaning that you can experience living in two Irish cities!
Academic Year Programme = 25 weeks

Accommodation Details

Executive Apartments in Galway are NOT AVAILABLE from 30th of June to 24th of August 2019

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.