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.