First Name:_________________________ Middle Initial:____ Last Name:______________________

ATA Member #:________________________ AATIA Member #:________________________

Employer/School:__________________________________________________________________
                                (Only list employer or school if you want it to appear on your badge)

Street Address:____________________________________ City:____________________________

State/Province:___________________ Zip/Postal Code___________ Country:__________________

Primary Telephone:____________________ Secondary Telephone:___________________________

Fax Number:_________________________ Email Address:_________________________________

SEMINAR REGISTRATION FEES

*Individuals who join ATA when registering for this seminar qualify for the ATA member registration fee. Please contact ATA or visit http://www.atanet.org/membapp.htm for a membership application.

Cancellations received in writing by August 29, 2003 are eligible for a refund. Refunds will not be honored after August 29. A $25 administrative fee will be applied to all refunds.

[ ] Check/Money Order: Please make payable, through a US bank in US funds, to American Translators Association.

[ ] Credit Card: Charge my

[ ] American Express

[ ] VISA

[ ] MasterCard

[ ] Discover

Card No. __/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__ Expiration Date:______________

Name on Card:___________________________ Signature:____________________________

Please send payment and completed form to: American Translators Association, 225 Reinekers Lane, Suite 590, Alexandria, VA 22314. OR, if paying by credit card, please fax completed form to: (703) 683-6122.

__Please check here if you require special accessibility or assistance. (Attach a sheet with your requirements.)

For more information about the Localization Translation Seminar or ATA Membership, please visit the ATA website at http://www.atanet.org or contact ATA at (703) 683-6100 or ata@atanet.org.