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Registration for the 2017-18 class is now closed.  Registration for the 2018-19 class will open in October 2017.

Full Name*

Informal

Your Title*

Organization*

Organization Address

Best Email Address

Cell Phone

Work Phone

Your Supervisor's Title

Years with Organization

Years in Present Position

Briefly describe the nature of your job responsibilities.

Please list your experience over the past 10 years, excluding your present position.

Educational Background

Degree

Institution

Specialization/Date Earned

Additional Degree

Institution

Specialization/Date Earned

NACDA Management Institute Levels Attended

Please state what you expect to gain as a result of attending the SMI Executive Program.

Billing Information/Send Invoice To:

Name

Title

Organization

Address

Phone

Upon acceptance to the program, an invoice for the deposit of $1,495 will be sent to the participant. The final balance of tuition ($2,000) will be due by May 1, 2018. Cancellations after April 1, 2018 will forfeit the deposit of $1,495.

Please check the box stating that you understand the deposit and cancellation information stated above.