Family Programme Registration Form

Family Programme Galway Registration Form
Digne

Personal Details of Family Group Members

Please give the details of the main conatct person for your family or group here:
Lucas
Digne
DD/MM/YYYY

Sofia
Digne
DD/MM/YYYY

Maria
Digne
DD/MM/YYYY

Leonardo
Digne
DD/MM/YYYY

Mario
Digne
DD/MM/YYYY

Elias
Digne
DD/MM/YYYY

Contact Details

lucasdigne@gmail.com
Please provide a mobile or landline number with international code

Emergency Contact Information

Martha Digne
marthadigne@gmail.com

Course Details

Accommodation Booking

Flight Details

EI 104 from Milan
Aer Lingus
Arrival Time
Aer Lingus
EI 104
Departure Time

Special Requirements

Do you or any of your family members 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.