School of Government Registration






Note: Fields marked * are required.

* Lastname:
* Firstname:
Middlename:
Suffix:
* Sex:	Male Female
* Preferred Name for Name Tag:
* Title:
Governmental Unit represented:
* Unit Represented:	Village
	Town
	City
	County
	State
	AOC
	Other:
* County:
* Business Address Line 1:
Business Address Line 2:
* City:
* State:
* Zip Code:
Home Address Line 1:
City, State, and Zip Code:
* Telephone:
Home Telephone (in case of inclement weather)
Cell Telephone (in case of inclement weather)
Fax Number:
* email:
* email repeated:

Additional Information Requested

Please list any special needs (ex: dietary, disability, etc.):

Refund Policy: Payment is due with registration. Cancellations up to one week prior to the workshop will be eligible for refund. Any cancellations made after that time will not be eligible for refund of the registration fee. Admission to all School of Government schools and conferences is without regard to race, color, religion, sex, national origin, age, disability status, veteran status, or sexual orientation. If you have a disability and need accommodation to participate in any Institute of Government program, please advise us.

* Payment Method:	Pay by Check School of Government Course 07775 Knapp Sanders Building CB#3330 Chapel Hill, NC 27599-3330 Bill by Purchase Order # Pay Online (enter information after submit)

In case of refund


Address to send refund check. If the refund check needs to be sent to a different address, please fill out the information below:

My refund address is the same as my billing address
* Name:
* Address:
Address:
* City:
* State:
* Zipcode:
Name on check: Is your payment credit card a: Personal Credit Card Business Credit Card * Name as it appears on Credit Card: Participant's name if different than name on credit card: