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Name

 

 

​​​Address

 

 

City, State, Zip

 

 

Telephone

 

  • Cell

 

  • Home

 

 

  • Work

 

 

  • Age, Date of Birth, Place of birth

 

 

  • Sex

    • Female

    • Male

  • Residence

    • US Citizen

    • Non-US Citizen

  • Degree

    • Associate             $ 795.00

    • Bachelor              $ 900.00

    • Masters               $1200.00

    • Doctorate            $2500.00

 

  • A non-refundable registration fee of $145.00 required with application.

  • Rates are subject to changes. 

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