for the Pharmaceutical
ATA Professional Development Seminar
Condado Plaza Hotel
and Casino •
San Juan, Puerto Rico •
Middle Initial:___ Last Name:___________________ ATA Member #:_________
(Only list employer
or school if you want it to appear on your badge)
Street Address:___________________________________________________ City:__________________________
State/Province:___________________________ Zip/Postal Code:______________
Primary Telephone:____________________________ Secondary Telephone:_______________________________
Fax Number:_____________________________ Email Address:_________________________________________
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.
(before January 16)
(after January 16)
Plant Tour Fees:
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
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. ___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___
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
to obtain the Registration Form.