registration form - Office of Continuing Professional Education

Office of Continuing Professional Education
10900 University Blvd. MS 4F2
Manassas, VA 20110
703-993-8335; Fax 703-993-8336; http://ocpe.gmu.edu
SCHOOL OF POLICY, GOVERNMENT AND INTERNATIONAL AFFAIRS
INTERNATIONAL SECURITY
SUMMER PROGRAM 2015
*This information is required to maintain a permanent record of your non-credit activity in Mason’s student information system. If this information is not
provided at the time of your registration the permanent record cannot be retroactively created.
(Please print your Full Legal Name as it appears on your state issued ID card or passport)
*  Mr.  Ms.
First
Please Check One
Middle
Last
G Number
(Mason ID #)
* Previous Name
(If used at Mason)
First
Middle
Last
Employer
Job Title
Work Address
* Home Address
City / State / Zip
* City / State / Zip
* Preferred Email
* Preferred Mailing Address
* Phone
Home
 Home
Work
Would you like to receive our monthly OCPE e-newsletter?

* Date of Birth
 Yes
Cell
 No
Arlington Campus –Founders Hall – 3351 Fairfax Drive, 22201
ST
IS 0410 A01 21 Century Terrorism
Monday-Wednesday
 IS 0300 A01 Pandemics, Bioterrorism &
International Security
 Work
Wednesday-Friday
July 13-15, 2015
July 22-24, 2015
OTHER DISCOUNTS -
Course Fee: $1195.00



Total $
- Discount $
Payment Total $
Alumni: $1095.00
Register more than one course: $1095.00 ea.
Association (3 or more): $1095.00 ea.
Method of Payment
VISA _____
MasterCard _____ Check _______
Name on Card (Please Print):
P.O. # _____
SF 182______
Cardholder Signature:
(RequiredCardholder Address:
(Required) Cardholder Phone:
Credit Card Number:
Expiration Date:
Refund Policy: We recognize you may occasionally need to cancel your registration. You can substitute another individual in your place prior to your
start. If you wish to receive a refund we must receive your request for cancellation no less than seven business days prior to the course start date. If you
request a refund, a $60.00 processing fee is deducted. We are sorry that we cannot provide a refund if we receive your written cancellation in six or fewer
business days before the start of the course. If you have requested a refund it may take several weeks to process. It is dependent on your method of
payment. Checks may take up to six weeks since refunds are cut through the Commonwealth of Virginia. Payments will be refunded to the
person/company that issued the original check to George Mason University. Processing of refunds to debit or credit cards will vary based on your financial
institution.