July 2010 Graduation Registration Verification Form

* Required fields
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 $115 in USA. $135 International rate.
Graduation Fee for attending ceremony, Regalia Fee, Bachelor's Degree, $300,00 ...Master's Degree - $330, Doctoral Degree $355.00....Indicate which degree you will receive: If You received your diploma in December your cost is $100 less.
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 16, Cost is $28.00 per person.
How Many Persons Will Attend Banquet With You?
Credit Card Information, If Paying Via CC

I have read and agree to the Privacy Policy *

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