Use the following form to apply to study at Berlitz Manchester

Your details

TitleMrMrsMissDr
Surname
First Name(s)
Street
City
Country
Postcode/Zip-code

Gender

Male Female 

Telephone
Fax
Email
Nationality
First Language
Date of Birth
Passport Number

Indicate your approximate level

Level:BeginnerElementaryPre-intermediateIntermediateUpper-IntermediateAdvanced

Course Details

Language to study
Start Date
Finish Date

Chosen Course:General English: 15 hours per weekGeneral English: 20 hours per weekBusiness EnglishCambridge Certificate ProgrammeIELTS PreparationUniversity Preparation ProgrammeTeacher TrainingExecutive Total ImmersionExecutive Crash Course

Accommodation

2 weeks notice is required for Homestay.

Would you like Berlitz to arrange accommodation for you?
Yes No 

Start Date
Finish Date
(Dates must be a Saturday or Sunday)
Religion
Any Special Requirements?

Yes No 

Insurance

Insurance is compulsory for staying in homestay. If you already have alternative insurance arrangements and are in homestay, please supply a copy of the policy in English by fax on +44 (0)161 236 4906.

Would you like Berlitz to arrange insurance cover?

Yes No 

Airport Transfer

Would you like Berlitz to arrange an airport transfer for you?

Yes No 

Single (£55) Return (£100)

Flight Details (if available)

We cannot confirm a transfer until we have your flight details.

Health

Do you take any medication?

Yes No 

If yes, specify:

Do you have any Allergies?

Yes No 

If yes, specify:

Do you have any special needs?

Yes No 

If yes, specify:

I agree with the Terms & Conditions: Yes