|
|
Translating
for the Pharmaceutical
Industry |
Registration Form
First Name:___________________
Middle Initial:___ Last Name:___________________ ATA 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: | ATA Member | Nonmember* | Payment | *JOIN
ATA NOW! Individuals who join ATA when registering for this seminar qualify for the ATA member registration fee. Please contact ATA or visit www.atanet.org/membapp.htm for a membership application. |
| Early-Bird (before January 16) | $145 | $260 | $________ | |
| Onsite (after January 16) | $215 | $330 | $________ | |
| Pharmaceutical Plant Tour Fees: | $70 | $95 | $________ | |
| NOTE: If tour does not meet required number of participants by January 16, tour may be canceled. Full refund of tour fee will be issued if cancellation occurs. | TOTAL: |
$________ | ||
Cancellation Policy: Cancellations received in writing by January 16, 2004 are eligible for a refund. Refunds will not be honored after January 16. 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: ATA, 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 ATA certification exam sitting will be held on Sunday, January 25. This will be a standard exam, not specialty-specific. Please visit http://www.atanet.org/accred.htm to obtain the Registration Form. |
For more information about ATA Membership, please visit the ATA website
at http://www.atanet.org or contact ATA at (703) 683-6100 or ata@atanet.org.