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, American Philosophical Association,
31 Amstel Avenue, University of Delaware, Newark, DE 19716
Payment must accompany your registration form.

Please print legibly. We use this information for your name badge.
Name: _________________________________________________________________
Affiliation: _____________________________________________________________
City: ____________________________ State: ________ Zip Code: _______________
Phone: __________________________ Email: _______________________________

Advance Registration Fees (Received by March 14, 2003 at the National Office)
______ $10.00 for APA Student Members
______ $50.00 for APA Regular Members
______ $60.00 for nonmembers

We will not accept any advanced registrations at the National Office past the March
14 th deadline. After that date you will need to register on-site in San Francisco.

Placement Registration Interviewers should fill out the Placement Service Registration Form located behind
this 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.

Credit Card Information (We accept Visa, Mastercard, and Discover only)
Please check one: ____ Visa ____ Mastercard ____ Discover
Print Legibly.
Credit Card Number: ____________________________________________________

Expiration Date: ___________ Cardholder:_________________________________
Signature: _____________________________________________________________

For office use only: _________ dep. code __________ ck. # __________ ck. date ________ amt. pd.