June 2009 Graduation Registration Verification Form

Name *
E-mail Address *
Telephone Number *
Cell Telephone Number *
Address *
City *
State *
Zip Code *
Country *
Will You Attend Graduation? *
International Mailing Information, Please list any other mailing information *
Name As It Should Appear On The Degree *
Degree Program - Please Identify The Exact Degree Program You Are Enrolled *
Please List All Courses You Have Completed For This Degree *
Please List The Title of Your Dissertation or D.Min. Project *
I do not plan to attend graduation, please ship my degree to me, cost is $90 plus postage.
Graduation Fee for attending ceremony, Regalia Fee, Bachelor's Degree, $280,00 ...Master's Degree - $310, Doctoral Degree $340.00....Indicate which degree you will receive::
Cap/Gown/Hood Information: All we need here is your height and weight for your gown. Please provide your height and weight *
Will you attend the Graduation banquet on Friday night, July 18? Cost is $24.95 per person.
How Many Persons Will Attend Banquet With You?
Credit Card Information, If Paying Via CC

* Fields marked with an asterisk are required fields

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