PACIFIC 2008
ADVANCE REGISTRATION FORM
MARCH 19-22, 2008, THE HILTON PASADENA, PASADENA, CA
Fax
this form with your credit card payment to Linda Smallbrook (302-831-3372).
No cover sheet is needed. Or, if you prefer, mail this form with your payment
to Linda Smallbrook, APA, University of Delaware, Newark, DE 19716.
Payment must accompany your registration form.
Please print legibly. This information is used for your name badge.
Name:________________________________________________________________
Affiliation:_____________________________________________________________
Email:________________________________________________________________
Advance Registration Fees (Received by March 3, 2008 at the National Office)
______$10.00 APA Student Members
______$50.00 APA Regular, International & Emeritus Members
______$60.00 Nonmembers
We
cannot process any advanced registrations at the National Office past the
March 3rd deadline. After that date you will need to register in Pasadena.
Placement Registration
Interviewers should also complete the Placement Registration Form. Candidates should check the space below if planning to use the service. Candidates must be a member of the APA in order to use the Placement Service. Placement is a free service for all current APA members.
I will be a job candidate. _____
___ 1) Check* (Payable to APA)
*The APA can only accept checks drawn on a U.S. bank, in U.S. Dollars.
___ 2) Visa____ MasterCard____ Exp. Date ____ ____ / _____ ___
Last 3
digits on back of card ____
____ ____
____ ____ ____ ____ -- ____ ____ ____ ____ -- ____ ____ ____ ____ -- ____
____ ____ ____
Name as it appears on Card: ________________________________________________________________
Signature of Authorization: ________________________________________________________________
Email:________________________________________________________________
Phone #: ________________________________________________________________