APPLICATION FORM

FIRST NAME: SURNAME(S):
GENDER: MALE FEMALE
DATE OF BIRTH:
COUNTRY OF RESIDENCE:
TELEPHONE: MOBILE PHONE:
E-MAIL:
CONTACT LANGUAGE: SPANISH ENGLISH CATALAN

TYPE OF ROOM REQUESTED:
SINGLE TWIN SINGLE STUDIO FLAT TWIN STUDIO FLAT
FROM: TO:
DISABLED ROOM REQUESTED: YES NO
CURRENT OCCUPATION: STUDENT OTHER
REASON FOR STAY: STUDIES WORK TOURISM CURRENT STUDIES:
STUDENT EXCHANGE PROGRAMME: YES NO
UNIVERSITY / SCHOOL OF ORIGIN:
UNIVERSITY / SCHOOL / COMPANY OF DESTINATION:

DO YOU WISH TO RECEIVE ANY PROMOTIONS RELATED TO OUR OR THIRD COMPANIES SERVICES?:
YES NO
HOW DID YOU HEAR ABOUT MELONDISTRICT?