American Translators Association
 Medical Division Mid-Year Conference
 InterContinental Hotel Cleveland • Cleveland, Ohio • May 31-June 3, 2007
Registration Form
First Name Middle Name Last Name ATA Member #
Employer/School (only list employer or school if you want it to appear on your badge) MiTin/NOTA Member #
Street Address
City State/Province Zip/Postal Code Country
Telephone Number Fax Number Email Address


Conference Registration Fees:
ATA Member*
Nonmember
TOTAL
Early-Bird Registration (by May 18):
$175
$230
$
Registration (after May 18):
$225
$255
Onsite (after May 25):
$280
$310
Mentoring Workshop (optional):
$15
N/A

*Michigan Translators/Interpreters Network (MiTiN) and Northeast Ohio Translators Association (NOTA) members can register at the ATA member rate.

Cancellations received in writing by May 25, 2007 are eligible for a refund. Refunds will not be honored after May 25. A $25 administrative fee will be applied to all refunds.

Join ATA and Save! If you join ATA when registering for this conference, you can take advantage of the ATA Member registration fee. For an application, contact ATA or visit www.atanet.org/membership/join_now.php.

Check/Money Order: Please make payable, through a U.S. bank in U.S. funds, to American Translators Association.
Credit Card: Charge my       VISA       MasterCard      American Express      Discover

Credit Card Number Expiration Date
____________________________________
Name on Card Signature

3 Ways to Register:
 • Register online at www.ata-divisions.org/MD/2007/register
• If paying by credit card, please fax registration form to (703) 683-6122
• If paying by check or money order, please mail registration form to ATA, 225 Reinekers Lane, Suite 590, Alexandria, VA 22314
DON'T FORGET!
Make your hotel reservations by May 10. Call the InterContinental at (216) 707-4100.
Please check here if you require special accessibility or assistance. (Attach a sheet with your requirements.)
An ATA certification exam sitting will be held Sunday, June 3. This will be a standard exam, not specialty-specific. To register, complete the Eligibility Requirements Form and Examination Registration Form.
For more information about the ATA Medical Division Conference, please visit www.ata-divisions.org/MD/2007 or contact ATA at (703) 683-6100 or ata@atanet.org.
DO NOT EMAIL THIS FORM. INFORMATION MAY NOT BE SECURE AND WRITTEN SIGNATURE IS REQUIRED.