This form can now be used for both online and offline payments.
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.
Personal Details
Mr.
Mrs.
Miss
Male
Female
Surname
*
First Name
*
Address
*
City
*
Post Code
*
Country
*
Nationality
*
Passport No
*
(or travel
doc.)
Date of Birth
*
(DD/MM/YYYY)
Place of Birth
*
Tel. No.
*
(with STD)
E-mail
*
Fax No.
(with STD)
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
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
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
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
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 Methodes
Online
Other
Card Type:
Surcharge:
£
Total Online Payment:
£
Please note you incur
a surcharge of 3.35% for American Express payments.
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.
