Duke Continuing Studies
Paralegal Certificate Program Registration Form
Please read our Cancellation Policies prior to registering.
Participant Information
First Name 
____________________________ Last Name__________________________________
Address 
________________________________________________________________________
City/State/Zip 
________________________________________________________________________
Daytime Phone 
(_____)________________________ Evening Phone(_____)_______________________
Email Address
 _________________________________________________________
Fax 
 (_______) __________________________
Organization/Company 
 ________________________________________________________________________
Job Title  
 ________________________________________________________________________
How did you hear about us?  _____________________________________________________________________
Program Information
PROGRAM ID #
TUITION 
IF CLASSROOM-BASED PROGRAM, START DATE AND CITY
____________
$ _________________
__________________________________________________________
Read the requirements for your program and sign below to certify that you have completed/met the requirements.
The Classroom-based Program Requirements       The Online Global Program Requirements

• An associates or bachelor's degree. (Transcript to be sent.)

      • A high school diploma.     

• An email account.

       • An email account.

• Fluency in the English language.

       • Fluency in the English language.

• Facility with computers, including word processing and internet skills.

       • Facility with computers, including word processing and internet skills.
        • Completion of the Test Drive.
Signature: ________________________________________________________________
Payment of Fees
Payment by Certified Check or Money Order: (Make payable to Duke University and include your name, as it is entered on the registration form, in the memo field.)     Check Number __________     Amount $ ________________
Payment by MasterCard/Visa: Credit Card Billing Information (please print)
     First Name__________________________________________ Last Name _______________________________________
     Address_____________________________________________________________________________________________
     City/State/Zip ______________________________________________Country(if not USA) __________________________
     Total Amount $ __________________                ____MasterCard           ____Visa
 
     Card Number __________  __________  __________  __________     Exp. Date _______ / _______

Loan:  __SLM   __TERI  __Other   Expected Date of App.: ________ Applicant's Name :  _____________________
Mail payment and form to:
Registration - Paralegal Certificate; Duke Continuing Studies; Box 90700; Durham NC 27708		  
Or fax to: 919-681-8235
Thank you! Your registration will be confirmed by email.