Luther King Module Registration Form

Module Registration Form
To register for your chosen module(s), please complete the following form.

Complete this form if you are registering to audit a module for no credit, to study a module as a taster course, or if you are signing up to our Summer or Winter Schools.

You can also use this form to register your group for a module with us, with a 10% discount!

Group Booking

Are you booking for a group of at least 5 people? If so, please indicate below. Booking as a group means that you or your organisation receive a 10% discount applied to the module booking.
Are you booking for a group or as an individual?
If you are booking for a group, please indicate the number of attendees below.

Group Booking Details

Please fill in this section to provide the details for each person included in your group.
Please fill in data for each person included below. You can add as many more fields as you require.

Which Module(s)/Course(s) do you wish to enrol on?

Full attendance is normally expected for all modules taken. If this is likely to be problematic, please let us know before enrolling on the relevant course(s).
Our list of modules and their codes can be found here.

If you would like to sign up for the Winter School, use the module code TMM40920

If you would like to sign up for the Summer School, use the module code TMM44420

If you would like to sign up for EXPLORATIONS, type "Explorations" into Module Code.

The list of modules includes all modules throughout the year. Please check the dates and times of the modules you wish to register for to make sure that they have not yet started and that they do not clash.

If you require residential accommodation for any nights, please book and pay for this directly with Reception.

website: https://direct-book.com/properties/lutherkinghousedirect

email: reception@lkh.co.uk

telephone: 0161 224 6404
Module Choices
If you are considering applying to study on one of our academic programmes and want to do a module as a formal “Taster” for academic study, please indicate below and we will get in touch to discuss this option with you.

Disabilities and Additional Needs

Completion of this section is optional. This information is requested so that we can assess your needs and help you access any appropriate learning support during the module(s). The information you provide below is special category personal data. If you do not want to provide it, leave this section blank. Providing information in this section indicates that you have given your consent for us to process the data in accordance with our data use policy at lutherking.ac.uk/policy
Are you registered disabled and/or do you have any additional support needs we should be aware of?
Please provide details above.

Emergency Contact
If you would like someone to be contacted in case of emergency, please give their name, address, contact number, and relationship to you here.

Fee Payment Arrangements

PLEASE NOTE: Fee payment should be made in full immediately if paying by card, or within 5 working days of invoicing you or your sponsor if payment is made by bank transfer. We cannot register you for the relevant module(s) until payment has been received. If payment is not received at least 5 working days prior to the start of your chosen module, we cannot guarantee that your registration will be processed in advance of the module start date.
How will the registration fee for your chosen module(s) be paid?
If you selected "Credit/Debit Card", you will receive an email from our finance team with a link to make your payment. When you pay, please note your name and "mod audit" for your payment reference.

Alternatively, card payments can be made through Reception.

email: reception@lkh.co.uk

telephone: 0161 224 6404.
If you selected "Sponsor/Organisation", please enter the contact details of your sponsor or Purchase Order number in the space provided. If this space is left blank after selecting "Sponsor/Organisation"), your registration will be invalid.
If you are a refugee, asylum seeker or in receipt of one or more income-based benefits (ie. Universal Credit, Tax Credit, Housing Benefit, JSA or ESA), a fee reduction of up to 30% is available. Please indicate in the box below if this applies to you. You WILL be required to provide evidence of this status.
Please enter details above.

Terms & Conditions
Please tick here to confirm that you have read and understood the Luther King Centre Payments & Fees Policy, Data Use Policy and the Library Terms and Conditions (accessible on our website: https://lutherking.ac.uk/policy/).
How did you hear about us?

Other
If you selected "Other", please provide details of this below.
I understand that I will not be registered for this module until payment has been received in full and that payment must be made at least 5 working days before the module start date.
Confirmation

I accept the terms and conditions set out in the relevant documentation, including those as laid out in the Data Use policy, and the Payments and Fees policy. I also accept the requirement for regular attendance as noted above. I agree to alert the Registry Office immediately, in writing, should I wish to withdraw from any course for which I register.
Typed name signature

First NameLast Name
Date

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2 digit month, 2 digit day, 4 digit yearDate
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Module Registration Form