ATA Medical Translation and Interpreting Seminar
Radisson Hotel and Suites Chicago
Chicago, Illinois, May 18, 2002

REGISTRATION FORM

First Name:____________________ Middle Initial:____ Last Name:_______________________

ATA Member Number:___________

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:__________________________ E-mail Address:_____________________________

SEMINAR REGISTRATION FEES:	ATA Member	Nonmember*
Early-Bird (before May 10)	$145	$230	$__________
On-Site (after May 10)	$225	$320	$__________
*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. </TD
TOTAL PAYMENT:			$__________
Cancellations received in writing by May 10, 2002 are eligible for a refund. Refunds will not be honored after May 10. A $25 administrative fee will be applied to all refunds. </TD

[ ] 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.)

An accreditation exam sitting will be held on Sunday, May 19. To register, please visit http://www.atanet.org/accred.htm to complete the Accreditation Examination Registration Form.