Medical Translation & Interpreting Seminar
Saturday and Sunday, March 22-23, 2003
Renaissance Biscayne Bay, Miami, Florida

REGISTRATION FORM

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

ATA Member #:_____________ FLATA 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:
BOTH DAYS,
MARCH 22-23:		 ATA/FLATA
Member		 Nonmember*  
Early-Bird
(before March 14)		 $180 - SAVE $15! $310- SAVE $25! $________
Onsite
(after March 14)		 $265- SAVE $20! $395 - SAVE $30! $________
SATURDAY,
MARCH 22:
ATA/FLATA
Member
Nonmember*
  
Early-Bird
(before March 14)
$145
$260
 $________
Onsite
(after March 14)
$215
$330
 $________
SUNDAY,
MARCH 23:
ATA/FLATA
Member
Nonmember*
  
Early-Bird
(before March 14)
$50
$75
 $________
Onsite
(after March 14)
$70
$95
 $________
 
TOTAL PAYMENT: $________


*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 March 14, 2003 are eligible for a refund. Refunds will not be honored after March 14. 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 Medical Translation and Interpreting 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.

An accreditation exam sitting will be held on Sunday, March 23. This will be a standard exam, not specialty-specific. To register, please visit http://www.atanet.org/accred.htm to obtain the Accreditation Examination Registration Form.

— An ATA Professional Development Seminar —