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* 1. Please enroll me as a:

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* 2. Applicant Information

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* 3. Name (as you want it to appear on your name badge):

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* 4. Name (as you want it to appear on your diploma):

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* 5. Association status:

Note: Bankers from outside of Georgia are cordially invited to enroll. If your bank is a member of your state banking association, we will extend the member tuition price to you. Non-member student tuition is $2,965.

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* 6. Total years in banking:

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* 7. Total assets of bank:

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* 9. What are your primary areas of responsibility? (Select all that apply)

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* 10. Indicate housing preference and requests below.

Two students will be assigned per room with two double beds. You may note a roommate request or GBA will assign a roommate to you. Please note the UGA Conference Center Hotel is a non-smoking hotel.

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* 11. Special hotel requests:

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* 12. Gender (for room assignment purposes):

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* 13. Check all dietary restrictions or allergies. Kosher meals are not available.

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* 14. Nominating Officer Information

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* 15. Upload a current photo for the Georgia Banking School student directory.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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* 16. Acknowledgment of School Commitment: I understand that, to qualify for graduation, I will be expected to attend all scheduled classes, prepare all assigned work, participate in classroom sessions, and satisfactorily complete all assigned home study problems. I hereby authorize the release of my grade to the GBA and my bank's CEO and/or nominating officer. This information is to be treated as part of my confidential personnel file.

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