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Seminar Registration - Form

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For more information on registration, please contact the API registrar at 703-715-3307 and 703-620-3611 OR Email us @ registrar@americanpressinstitute.org .


required fields are marked by a *
los campos requeridos son marcados por *
Seminar Information / Informaci�n Del Seminario
Please select the seminar you are interested in: *
/ Seleccione el seminario en que usted está interesado:

Personal Information / Informacion Personal
Please tell us who you are. This information is used to tie you into our Registration Database. If you have any concerns, please read our Privacy Statement. Please note, this information is required to make sure that you are signed up.
Por favor díganos quien es usted. Esta información se utiliza para atarle en nuestra base de datos del registro. Por favor anote, esta información se requiere para asegurar que usted esta inscrito.
Prefix /
Prefijo *
First Name /
Nombre*
M.I. /
Inicial
Last Name /
Apellido *
Suffix / Sufijo Nickname / Apodo
Birth Month / Mes Del Nacimiento* (i.e. 03)
Birth Date / Fecha Del Nacimiento* (i.e. 12)


Occupation Information /Informaci�n De la Ocupaci�n
Please tell us about your job. / Por favor informenos sobre su trabajo.
Job Title-Position
/ T�tulo Del Trabajo-Posici�n *
Company-Organization /
Compa��a-Organizaci�n*
Group Affiliation /
Afiliaci�n Del Grupo
Street Address /
Direcci�n De la Calle*
Post Office Box or Suite No. / Apartado de correos u N�mero De la Habitaci�n City / Ciudad *
State / Estado Country / Pa�s*
Postal (Zip) Code / C�digo Postal (Del Cierre rel�mpago) * Business P.O. Box Zip Code (if different from street address) / C�digo postal de P.O. Box Del Negocio (si es diferente de la direcci�n de la calle)
Is this the company/organization main address? / �Es �sta el company/organization direcci�n principal?    No
If no, describe office (bureau, printing press, etc.) / Si no, describe la oficina (oficina, prensa etc.)


Contact Information / Mas Informaci�n
How can we get in touch with you? / �C�mo podemos conseguirle en tacto con?
Phone / Tel�fono* Extension / Extensi�n
Fax E-mail *
  Secondary E-mail / Segundo E-mail
 


Supervisor Information / Informaci�n Del Supervisor
Who made the decision enabling you to attend this seminar? / �Quién tomó la decision para permitierle ateneder a este seminario?
Prefix /
Prefijo*
First Name /
Nombre *
M.I. /
Inicial Media
Last Name /
Nombre Pasado *
Suffix / Sufijo  
 
Supervisor Title - Position / T�tulo Del Supervisor - Posici�n*  
 
Supervisor Phone Number / N�mero De Tel�fono Del Supervisor* Extension / Extensi�n
Address (if different from above) / Direcci�n (si es diferente de antedicho)


Discount Information - Contract Code / Informaci�n Del Descuento - C�digo Del Contrato
If you were given a promotional code on an API mailing or postcard,

OR

if this registration is part of a contract with API, please enter the code below.

Si le dieron un promocional cifre en un correo o la postal del API O si este registro es parte de un contrato con el API, introduzca por favor el c�digo abajo.

Does your company have a 2010 API Dollar Match Program account? If so, you must enter your code in the "Promotional Code" field below.
Promotional Code / C�digo Promocional


Additional Instructions / Instrucciones Adicionales

If you have any special instructions for the registrar regarding your registration please insert them below. / Si usted tiene algunas instrucciones especiales para el secretario con respecto a su registro por favor insertarlas abajo



I have previously participated in an API Seminar /
He participado previamente en un seminario del API   

I would like to be sent e-mails regarding API news /
Quisiera ser enviado los E-maices con respecto a noticias del API    Yes    No
How did you hear about this seminar? / ¿Cómo se entero usted de este seminario?

 

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