smi-logo-alt-72x72-apple-iPad

Registration for the 2019-20 class is now open. Registration for the 2020-21 class will open in October 2019.

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, 2019. Cancellations after April 1, 2019 will forfeit the deposit of $1,495.

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