Course Registration

Use the following form to apply to study at Berlitz Manchester

Your details

Title Mr Ms Mrs Miss Dr

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

MaleFemale Telephone Fax Email Nationality First Language Date of Birth (dd/mm/yyyy) Passport Number

 

Indicate your approximate level

Level: Beginner Elementary Pre-intermediate Intermediate Upper-intermediate Advanced

 

Course Details

Language to study Start Date Finish Date

 

Chosen Course: General English: 15 hours per week General English: 20 hours per week Business English Cambridge Certificate Programme IELTS Preparation University Preparation Programme Teacher Training Executive Total Immersion Executive Crash Course

 

Accommodation

2 weeks notice is required for Homestay.

Would you like Berlitz to arrange accommodation for you?

YesNo Start Date Finish Date

 (Dates must be a Saturday or Sunday)

Religion YesNo Any Special Requirements?

 

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?

YesNo

 

Airport Transfer

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

YesNo 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?

YesNo If yes, specify:

 

Do you have any Allergies?

YesNo If yes, specify:

 

Do you have any special needs?

YesNo If yes, specify: