Enrollment Form
First Name (*)
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Last Name (*)
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E-mail (*)
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Day Phone
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Evening Phone
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Street
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City
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State
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Zip
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Country
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Please briefly describe your present skills & professional background:
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How did you hear about the program?
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Choose the program you are interested in:
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For online participants:

Choose the weekends you plan to attend live in NY.
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Payment Options

Filling out the following section requires that you talk to our Admissions Advisor first. Please call (646) 812-0091 to discuss the discounts and payment options.

1. I am making a $600 deposit and will be making monthly payments. Please enter the number of months of your payment plan.
Payment plan:
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2. I am paying for the course in full and receiving a discount. Please call the Admissions Advisor at (646) 812-0091 to receive your discount and enter the amount here.
Discount amount:
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Pay by check:
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3. I will pay by check. Check if this applies.
4. I will pay by credit card. (For security, please call to pay over the phone.)
Pay by credit card:
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What discounts apply to you? (Call us to discuss the applicable discounts )
Applicable discounts:
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What is the total fee due?
Total due:
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Terms and Conditions

Terms
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Enter the security code: (*) Enter the security code:
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