Knapp Building

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* Lastname: 
* Firstname: 
Middlename: 
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* Sex:   Male  Female
* Preferred Name for Name Tag: 
* Title: 
Governmental Unit represented: 
* Unit Represented:   Village
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   State
   AOC
   Other:
* County: 
* Business Address Line 1: 
Business Address Line 2: 
* City: 
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* 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: 

* Payment Method:   Pay by Check

School of Government
Course 08645A
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
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* Address: 
Address: 
* City: 
* State: 
* Zipcode: 
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* Name as it appears on Credit Card:


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