REGISTRATION FORM INSTRUCTIONS

This form has been designed for those wishing to register on-line, but not pay on-line. With this form you will be able to make payment with Mastercard, Visa, or personal check and mail the payment to us. However, if you would prefer to make a credit card payment on-line please CLICK HERE to go to the credit card registration web page instead.

Please complete all fields and questions contained in this form and register only one person per form. Once you have filled in all sections, print a copy of the form, before clicking the Submit button.

Click the box for the registration category that you prefer. Print a copy of the form on the screen, then click the submit button. Our office will receive a date-stamped email version of your registration form. You will still need to print the confirmation page that comes up on your screen after you click Submit. Then mail a copy of the registration form or the confirmation page with your payment.

Mailing address: NCSU-FEOP, Campus Box 8008, Raleigh, NC 27695-8008
Fax number: 919-515-6883, Our phone number: 919-515-9563

Confirmation of your registration will be emailed to you after payment is received.

First Name:
Last Name:
Title:
Organization:
Mailing Address:
City, State, Zip
Phone:
Fax:
E-mail: (required information)
Your Preferred Payment Method:	Check payable to "NC State University" mailed in with copy of this form. Mastercard or Visa entered by hand after printing this form, then mailed or faxed. County, City, State or Federal agency requesting invoice.
Space to hand write your credit card information if paying with card.	Card number: _________ - _________ -_________ -_________ (MC or Visa only) Expiration Date: ___________ Name of cardholder: ________________________

Don't forget to print a copy BEFORE you click the button below!