English Courses - Manchester based Berlitz Language School

Berlitz Manchester
19 Lever Street
Manchester
M1 1BY

Tel: 0161 228 3607
Fax: 0161 236 4906

info@berlitzmanchester.com

Name Details:

Mr Ms Mrs Miss Dr

Surname: *

First Name: *

Address Details:

Street: *

City: *

Country: *

Post Code: *

Gender

Male Female

Phone Number: *

Fax Number:

E-Mail: *

Nationality: *

First language:

Date of birth: *

Passport Number:

Day/Month/Year

Please send a photocopy of your passport

What language do you want to study?

Please tick box for your approximate level
Beginner	Elementary	Pre-intermediate
Intermediate	Upper-intermediate	Advanced

Please tick where you found out about Berlitz Language Centre
Yellow Pages	British Council	Internet
Walk in	Friend	Other

Course - Please tick the Course you would like to Study

Start Date:

Finish Date:

General English
Full Time (20 Hrs/Week)
Part Time (15 Hrs Per Week)

Business English

Crash Course

Foundation Programme

Total Immersion

IELTS Preparation

One to One

Other (Please State below)

Other (details)

Accommodation:

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

2 Weeks Notice required for Homestay

Start Date:

Finish Date:

Must be Saturday or Sunday

Religion:

Do you smoke?

Yes: No:

Special requirements?

Yes: No:

Please Specify Below

Insurance

Insurance cover is compulsory for staying in homestay

Would you like Berlitz to arrange insurance cover	Yes	No
If No and staying in homestay, please supply a copy of the policy in English by fax on +44 (0)161 236 4906. Otherwise we will add insurance onto your invoice.

Airport Transfer

Would you like Berlitz to arrange an airport transfer	Yes	No
Single (£50): Return(£100):
Please State your flight details if available:
We cannot confirm a transfer until we have your flight details.

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