CENTRAL 2007
ADVANCE REGISTRATION FORM
APRIL 18-21, 2007, THE PALMER HOUSE HILTON, CHICAGO, IL
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 28, 2007 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 21st deadline. After that date you will need to register in
Chicago.
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 ________
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