API 510 Test Registration Applicants Name:

_________________________________________

API Exam ID # (If previously assigned):

Examination Locations and Dates
Please indicate your preferred exam date and location listed below. December 5, 2012 (Application Deadline API must receive no later than September 17, 2012) June 5, 2013 (Application Deadline API must receive no later than March 20, 2013) September 25, 2013 (Application Deadline API must receive no later than July 10, 2013) Application deadlines are firm no exceptions will be made.

*NOTE: An additional sitting fee will be required at the Edmonton location in December. You will
receive information, prior to the exam date, from ABSA / API, with payment instructions.

North America:
Anchorage, AK Atlanta, GA Baton Rouge, LA Corpus Christi, TX * Edmonton, AB (Canada) Houston, TX Indianapolis, IN Los Angeles, CA Oakland, CA Oklahoma City, OK Philadelphia, PA

Other Locations:
Abu Dhabi, UAE Al-Khobar, Saudi Arabia Cairo, Egypt Chennai, India Chia, Colombia Doha, Qatar Kuala Lumpur, Malaysia Mumbai, India Port of Spain, Trinidad Safat (Kuwait City), Kuwait Singapore, Singapore United Kingdom (contact API for city info)

If a location of your choice is not listed above please contact API for more information. If you are testing at an API-approved special site, please include the location and/or group here:_________________________________________ City, Country

> > THIS FORM MAY ALSO BE USED TO RESCHEDULE A TEST << If rescheduling, please remember to include the re-test fee.

API 510 - PAYMENT INFORMATION Applicants Name: _________________________________________

Exam ID # (If previously assigned):
API member rate applies to full-time, non-contract employees of API-member companies.

API Member
$600.00

Non Member
$800.00

PAYMENT INSTRUCTIONS
All payments must be made in United States currency. Checks must be drawn on a U.S. bank. You are responsible for all taxes, banking or other service fees, including all applicable withholding taxes. Applicants name(s) must be included on the check. For payments by electronic transfer: (1) you are responsible for all electronic transfer, A.C.H. and banking fees (be sure to add the fees to your payment); (2) for electronic payments not drawn on a U.S. bank a fifty-dollar ($50) handling fee must be added at the time payment is made. Please include a copy of the wire / electronic transaction. Applicants name(s) must be included on the transaction document.

PAYING BY CREDIT CARD CAN EXPEDITE THE PROCESSING OF YOUR APPLICATION AND PAYMENT TO ENSURE YOUR PLACE IN THE EXAMINATION.
Credit Card Type: Card Number: Visa American Express Expiration Date: _____________________________________________
Initial Certification Fee Reschedule / Retest Fee

MasterCard

Name as it appears on card Signature

_______________________________________

E-mail address to send receipt:

Check

($150.00)
Late Penalties Bank Fee (if wired)

Wire Transfer to:

TD Bank
1030 15th St NW Washington, DC 20005 USA ABA Routing # 054001725 Credit to: American Petroleum Institute Account # 4251303172 SWIFT: NRTHUS33

TOTAL SUBMITTED

(Reference: Applicants Name and SS-2100-D9200-7110) Your application will not be processed if this page is not completed.