West Coast ATA Chapter - Registration

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Additional Attendees Registration:

Thank you for your interest in the ATA Compliance Seminar - May 12, 2008.
Our West Coast Chapter is excited to have you as their guest at this important event.
Please complete the following information to register.

** If you have more than 2 attendees from your company and you prefer to pay by check or offline, you can print this registration form and mail or fax it in. If paying by check, please print the registration form and mail with your payment. Please note that no additional registrations are accepted without payment.

Contact Information:
First Name:
Last Name:
Company:
Job Title:
Mailing Address:

City:
State:
Zip Code:
Telephone:
Fax:
E-mail:

How did you hear about this event?
	Website	Chapter Member
	Newsletter	E-mail
	Colleague	Other
	ATA Staff

Registration Fee:
	Member $150
	Non-Member $200

Method of Payment:
Credit Card:
Card Number:
Name on Card:
Expiration Date:

By clicking the submit button, I agree to authorize above total amount according to card issuer agreement.


Event Cancellation Policy: Cancellations to events must be made in writing and received no later than two weeks in advance of the event date to receive a full refund. Those cancellations received after that point are non-refundable.

American Teleservices Association
3815 River Crossing Parkway, Suite 20
Indianapolis, IN 46240
317.816.9336 ● www.ataconnect.org