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Applicants Name:
Exam ID #
_________________________________________
September 25, 2013 (Application Deadline API must receive no later than July 10, 2013)
North America:
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Edmonton, AB (Canada)
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Los Angeles, CA
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Mumbai, India
United Kingdom
(Contact API for city info)
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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.
571_2013 (Revised2)
API Member
Non Member
$225.00
$275.00
PAYMENT INSTRUCTIONS
Visa
American Express
Card Number:
Expiration Date:
MasterCard
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_______________________________________
($75.00)
Late Penalties
Bank Fee (if wired)
TOTAL SUBMITTED
TD Bank
1030 15th St NW
Washington, DC 20005 USA
ABA Routing # 054001725
Credit to: American Petroleum Institute
Account # 4251303172
SWIFT: NRTHUS33
571_2013 (Revised2)
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