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?*

I am booking for at least 5 people.I am not booking for a group
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 require residential accommodation for any nights, please book and pay for this directly with Reception, requesting the student rate:

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.

I wish to study a "Taster" for potential credit before beginning a formal course.I wish to study my module choices not for credit.I am unsure/wish to discuss these options further.

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 protection 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

PLEASENOTE: Any fee must be paid in full two weeks before the module. Registrations received less than two weeks before the module must be submitted with payment required the same day of submission/registration.
How will the registration fee for your chosen module(s) be paid?

Bank TransferSponsor/OrganisationCredit/Debit Card
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://www.lutherking.ac.uk/community/policies)
How did you hear about us?

Word of MouthChurch CommunityLocal CommunitySocial MediaWebsiteInternet SearchAdvertisingAn eventOther
If you selected "Other", please provide details of this below.
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

MonthDayYear
Date
Should be Empty:

Module Registration Form