Fill out the form below. Fields marked with * are required!

Please indicate program you are applying for:*

February 20-22, 2012

Classes will be held at Loews Vanderbilt Hotel
Nashville, TN

DISCOUNTED TUITION DEADLINE: January 31, 2012

• TBA cannot accept applications after February 6, 2012

Tuition*
Payment-in-full is required with this application. Cost of housing and meals is not included in tuition fees.

Discounted Tuition (applications received by January 31, 2012):

 Discounted Tuition - TBA members/sponsors $970
 Discounted Tuition - Nonmembers: $1,120

Any applicant withdrawing after January 31, 2012, but before February 6, 2012, will be refunded all fees except a $150 cancellation fee. There is no refund, with the exception of extenuating circumstances, if a registrant withdraws after February 6, 2012, or fails to attend the school. Refund requests must be submitted in writing to TBA.

Applicant Information

First Name*:
Last Name*:
Nickname*:
Title*:
Email Address*:
SS# (for tracking grades)*
Date of Birth:
Bank Name*:
Bank Address*:
City*:
State*:
Zip*:
Bank Phone*:

 


Housing*

Tuition does not cover housing. If you would like to stay at the Loews Vanderbilt Hotel, TBA must reserve your accommodations.

Do you wish the TBA to reserve a room for you at the Lowes Vanderbilt Plaza Hotel? If yes, please indicate which nights you will stay:*

Yes
Sunday, February 20
Monday, February 21
Tuesday, February 22
No (if no, skip to next section)
If you want a private room, click SINGLE. Please note that rates are $120 double/$170 single per night. Double - $120 per night/person
Single - $170 per night
Background information is helpful when assigning housing:

Nonsmoker
Smoker

Male
Female
Roommate preference:
(Roommate requests are accommodated when possible. To request a specific roommate, write in his/her name. If you do not have a preference, write NO PREFERENCE and the school will assign a roommate.)

 

Professional Information:

Education Background*:
(Select highest level attended)		 High School
Some College
Associate Degree
Bachelor's Degree
Graduate Degree
Total Years of Banking Experience* Less than 1 year
1-5 years
6-10 years
11-20 years
Over 20 Years
Total Years of Commercial Lending Experience* Less than 1 year**
1-5 years**
6-10 years
11-20 years
Over 20 Years

** Any bank experience and/or commercial lending experience less than 3 years requires written documentation from the CEO or the nominating officer supporting the request to waive this prerequisite.

 
Size of Bank's Loan Portfolio* Under $1 million
$1-$5 million
$6-$10 million
$11-$50 million
$51-$100 million
Over $100 million
Size of Bank (Assets)*

Under $50 million
$50-$100 million
$101-$500 million
$501 million-$1 billion
Over $1 billion
Other

 


Education

High School/Prep:

Name of School
Year Graduated
Degree Received (if any)

College:

Name of School
Year Graduated
Degree Received (if any)

Graduate School/Banking School:

Name of School
Year Graduated
Degree Received (if any)

Other Relevant Training:

I have read the admission requirements and desire to enroll in the school. In applying for admission, I understand that I will be expected to attend all classes, to prepare assigned work, and to abide in all respects to the standards established by the school. I agree to the code of ethics set forth by the school. I authorize the school to release my completion status to the management of my institution upon written request from my CEO or nominating officer.

Applicant's initials*: Date*:

Nominating Officer's initials*: Date*:

Nominating Officer's Name*: Title*:
(please type "Same as Above" if applicant is CEO or president)

 

This institution does not discriminate with regard to race, religion, gender, or age.


Payment-in-full is required on the next page