Philadelphia, PA
December 27-30, 2002
Only one form is required for each interviewing department.
All persons who will be involved in conducting interviews should
be registered for the Eastern Division Meeting as well as with the Placement Service.

Institution: _______________________________ Contact: ______________________
Department: _______________________________ Phone: ________________________
Address: _______________________________ Fax: ________________________
_______________________________ Email: ________________________

Members of the department who will be conducting interviews:
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________

Our department will: ____ be conducting interviews in a hotel suite (Please Check One)
____ Need an interviewing table Quantity of Tables ___

Registration Fees: ____ Pre-Registration: $50: By December 16 (Please Check One)
____ * On-Site Registration: $75: After December 16

Credit Card Type: VISA / MASTERCARD / DISCOVER (Circle One)
Credit Card #:
Expirtaion date:

Name on Card:______________________________ Phone #: ____________________
Signature: _____________________________________ E-mail: ____________________
** Check #: ____________ Check Date: ___________ Check Amount $ ________

** Make checks payable to: The American Philosophical Association.

The APA only accepts checks drawnon U. S. banks in U. S. funds,
or Intl Money Orders in U. S. funds. There is a $20 charge for all returned checks.
*If PAYMENT is not received in our office before December 16, you MUST pay the on-site fee!

Please mail form and payment to:
Attn: Connie Lilly, Placement The American Philosophical Association
31 Amstel Avenue, University of Delaware, Newark, DE 19716
Credit card payments can be faxed to (302) 831-8690.

OFFICE USE ONLY
PAID # __________ S/ T ___________ INV # ____________ QTY ___________