USAT-MAC :: USAT-MAC Application to Host Seminar

Application to Host

USAT-MAC Seminar

Name and Describe Your Event*

Name of Host State*

Name of Host School*

Full Name of Host Instructor*

First Name Last Name

Rank of Host Instructor*

Organization which Certified Instructor's Rank*

Date of Proposed Seminar*

Month Day Year

Length of Seminar*

2 Hr. Minimum 4 Hr. 6 Hr. Recommended 8 Hr.

Full Name of Contact Person*

First Name Last Name

Address of Contact Person*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number of Contact Person*

- Area Code Phone Number

E-mail of Contact Person*

Name of Seminar Location*

Address of Seminar Location*

Street Address
Street Address Line 2
City	State / Province
Postal/Zip Code	Country

NOTE: After Submitting this Form, you will be taken to the Payment Page where the Sanction Fee ($100.00) is paid. The Sanction Fee is non-refundable as it is used to cover the costs of setup and administration.

Enter the message as it's shown*