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Registration

Program Name and Date

Seminar

Personal Information

Preferred Prefix

First Name

Last Name

Preferred Name or Nickname

Business Address

Telephone

Fax

Title

Organization

Industry Classification

UNC-Chapel Hill Alum

Kenan-Flagler Alum

Management Level

Position Classification

Year of Birth (yyyy)

Highest Degree Received

Date Received

Organization Data

Sales in U.S. Dollars

Number of Employees

Product Line or Service

Name of Parent Organization

Person who makes decisions about executive development for your company

Name

Title

Business Address

Telephone

How did you hear about this program?

Please check this box to indicate that all supplied information is accurate and that the applicant agrees with the Kenan-Flagler Executive Development conditions for cancellations and transfers. This application cannot be processed without this agreement.

Agree

Please check if this is a group registration

Group Registration

Program Certificate Code

Please check if Program Certificate used by self

Self Registration

Program Certificate transferred to me by (name)

Payment Options

Please send me an invoice.
Please charge the seminar tuition to my credit card.