Student Application Form Any agents wishing to book a course on behalf of a student please contact the marketing department at English@manacad.co.uk Please select a course, click on the course code then select duration and fee. For more information about the courses please click here. Alternatively, if you want to view your payments summary or to pay the balance from a previous invoice click here.   Type of Course Course Code Duration       Price(£) Beginning on (any Monday)   Fields with * are compulsory. If you wish to book a course starting on the week of 24th November 2008 and the week of 1st/8th December 2008, please call us to check availability on (+0044) 0161 237 5619 (Mon, Wed & Fri 9:00am-5:30pm, Tues & Thurs 9:00am-8:30pm). Personal Details   Mr. Mrs. Miss Male Female Surname  * First Name * Address  * City * Post Code  * Country * Nationality  * Date of Birth  * (DD/MM/YYYY) Tel. No. * (with STD) Fax No. * (with STD) Passport No * (or travel doc.) Place of Birth * E-mail * Date of entry into the United Kingdom if already in the U.K   (DD/MM/YYYY) Your Profession or Occupation Education Level of Education: University College Secondary School Languages Spoken: What do you think is your level of English?* Complete Beginner Elementary Pre intermediate Intermediate Upper Intermediate Advanced Accommodation Do you want the Academy to arrange accommodation for you? * Accommodation      Type Duration    Price(£)  Homestay Select a Type Standard diet - Half Board Kosher - Full Board        Self-catering  None Beginning Date:*    Accommodation starts Saturday or Sunday before course date and finishes Saturday or Sunday after leaving date.  if yes then please complete this section as well: Your religion Degree of observance Do you take any medication?* Yes No if yes, please specify Do you have any allergies?* Yes No if yes, please specify Do you have any physical handicap?* Yes No if yes, please specify Do you have any existing medical conditions?* Yes No if yes, please specify Have you seen a doctor or been admitted to a hospital in the last 12 months?* Yes No if yes, please specify Please provide us the contact details of who we should contact in case of emergency:* Full name: Telephone number: (include ISD code, eg +44 for England) Email address: Relationship: Do you smoke? Yes No Any special diet?* No Vegetarian Food Kosher Others if others, specify Airport Transfer Single journey from Manchester Airport to the accommodation Would you like the Academy to arrange an airport transfer for you?  Yes    Single = £60 Return = £120  No Insurance Personal liability insurance cover is highly recommended when staying in MARSA and homestay. See terms and conditions. Would you like the Academy to arrange insurance cover? Yes    No If no, please supply a copy of your own Insurance policy in English. Otherwise you are responsible for all costs if any damage occurs. Source of Information   How did you come to know about us ?* Yellow Pages British Council English UK Passing by Recommended Other Internet Google Yahoo MSN Altavista InfoSeek Lycos Other Terms and Conditions I have read the terms and conditions and understood and agreed to the conditions of enrolment.* Fees & Deposits   25% of the tuition fees £ Registration fee £ Accommodation fees (Includes booking fee)                    £ Airport transportation fee £ Insurance (If required) £ Payment Options Total Deposit:   £ Includes 25% course fee, £35 registration fee, 1 week homestay with £35 booking fee, insurance, airport transfer, as applicable Full Payment: £ Includes Course Fees, Registration, Accommodation, Transportation and Insurance Payment Methods   Online Other   Card Type: Other Credit/debit American Express Surcharge: £ Total Online Payment: £ Please note we do not accept American Express cards Pay by bank transfer, cheque, bank draft or cash. The Academy will only reserve places for a student when a deposit or full payment is obtained.