Duke University
The Fuqua School of Business Executive Education
High Potential Executive Program
September 27-October 2, 2009 & November 8-13, 2009
 

Please note: This is a three step process


Step 1. Complete the application on this page.
Step 2. Complete the billing information on the next page.
Step 3. Submit and receive a confirmation.
 
Failure to complete all 3 steps will void your registration.

* indicates a mandatory field.

First Name*  
Last Name*  
Title*  
Company/Institution Name*  
Company Code (if you have one)  
Business Address 1* (No PO Boxes)  
Business Address 2  
Business City*  
Business State*  
Business Zip*  
Business Country*  
Business Phone*  
Business Fax*  
E-Mail*  
How did you learn about the program?  
If advertisement, please specify publication  
If other, please elaborate  
Company Sales Last Year (US$)*  
Your budget responsibility*  
Number of persons you manage*  
Years at current position*  
Years of management experience*  
Describe the nature of your current responsibilities*  
Highest Degree Earned*  
School  
Position Classification*  
Level*  
Industry Classification*  
     
Who is the person responsible for management development in your organization?
  
     
First/Given Name  
Last/Family Name  
Title  
Business Address  
Business Address 2  
City  
State/Province  
Zip/Postal Code  
Country  
Email  
Phone  
Fax