Junior Registration

Use the following form to apply for study on a Junior Course at Berlitz Manchester

Your details

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

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

 

Indicate your approximate level of English

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

 

Course Details

Start Date Finish Date

 

Chosen Course: General English: 15 hours per week Semi Intensive: 20 hours per week Manchester United Soccer School

 

Extras

Sport Plus Activities

Golf

Basketball

Watersports

Tennis

Karate

Horse Riding

 

Insurance

Insurance cover is compulsory for junior residential programmes. 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

 

Flight Details (if available)

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

 

Addional Information

If no accommodation is required, please state the address of where the student will be staying

Address:

 

Please give details of any allergies, dietary requirements or medical conditions

If yes, specify: