Register Right Away - Winthrop University

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Certificate in Non-Profit Management. Registration Form 2016-2017. Please provide a COMPLETE mailing address to receive
Certificate in Non-Profit Management Registration Form 2016-2017 Please provide a COMPLETE mailing address to receive confirmation.

Name __________________________________________

Title ______________________________

Name as preferred on certificate

Organization Name ____________________________________________________________________ Organization Address _________________________________________________________________ Street or P.O. Box

_________________________________________________________________ City

State

Zip

Home Address _______________________________________________________________________ Street or P.O. Box

_______________________________________________________________________ City

Mobile Phone__________________

State

Work __________________

Zip

Home _____________________

Email ________________________________________________________________________________ Do you have any food allergies or restrictions? _____ If so, please list: ___________________________ ______________________________________________________________________________________ Please list any medical issues of which we need to be aware? __________________________________ Course Fee: In-State (SC) Tuition- $425, Out-of-State Tuition-$525 (includes tuition, materials, and lunches. Can be paid in 2 equal installments of $212.50 each for In-State and $262.50 for Out-of-State.)

Payment: Payment will only be processed if accepted into the program. Amount: _________ Check # __________ (payable to Winthrop University Institute of Management) MasterCard __ Visa __ Card Number___________________________________ Exp. Date __________ Security Code: _________ Register by mail, fax, or phone. Send registration form to: Celeste Tiller, Director, The Institute of Management, Winthrop University, 213 Thurmond Building, Rock Hill, SC 29733 Phone 803/323-2409 or FAX 803/323-2539 *If a cancellation notice is received one week prior to the start of class a cancellation fee of ½ the course fee will be charged. There will be no refunds for registrants who fail to show up to class. Substitutions are allowed.