Ila Opi Sample Form – Fill Out and Use This PDF

I LA

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I N TER- AM ERI CAN LAN GU AGE ASSOCI ATES, I n c.

I LA Or a l Pr of icie n cy I n t e r v ie w ( OPI ) Re g ist r a t ion For m

Please r ead t he r equir em ent s for r egist r at ion befor e com plet ing t his r egist r at ion for m . I n co m p le t e

r e g ist r a t ion f or m s w ill b e r e t u r n e d . Th is is a t w o - p a g e d ocu m e n t .

Please see Fr eq u en t ly Ask ed Quest ions for im por t ant infor m at ion .

1 . Pe r son a l I n f or m a t ion ( Pr int one let t er in each space for nam es. )

PLEASE PRI N T CLEARLY

L M r .

Cir cle On e :

M iss

M r s. M s.

D r .

Fam ily Nam e

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Fir st Nam e

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Addr ess _____________________________________________________ Apar t m ent ____________

	NUMBER	STREET			NUMBER AND/ OR LETTER
Cit y , St at e, Zip	____________________________________________________________________
Hom e Phone Num ber		_____________________	Mobile Phone	_____________________
Dat e of Bir t h	__________________________		Em ail Addr ess	_____________________
					PLEASE PRI N T CLEARLY
Nat iv e Count r y	__________________________		Nat iv e Language	_____________________

4 . Ch e ck On e : I giv e I LA per m ission t o use m y r ecor ded int er view for r esear ch and inst r uct ional pur poses only .

 Yes No

5 . Pa y m e n t : The fee for t he I LA OPI is $ 150 . 00 and is pay able only by per sonal check , m oney or der , or U. S. post al m oney or der . For eign check s m ust be pay able t hr ough a Unit ed St at es bank . Please

m ak e y our pay m ent pay able t o I LA and m ail it w it h t his com plet ed r egist r at ion for m t o:

I N TER- AM ERI CAN LAN GU AGE ASSOCI ATES, I N C. 6400 Balt im or e Nat ional Pik e # 211

Cat onsv ille, Mar y land 21228

I m p o r t a n t :

*	Th e of f ice s of I n t e r - Am e r ica n La n g u a g e Associa t e s a r e N OT loca t e d a t t h e a d d r e ss
	a b ov e . I n t e r v ie w s a r e n ot con d u ct e d a t t h e a b ov e a d d r e ss.
*	I LA OPI r e g ist r a t ion ca n b e m a d e on ly b y U . S. m a il or a d e liv e r y se r v ice ( Fe d Ex , U PS)
	t o t h e a b ov e a d d r e ss. Re g ist r a t ion ca n n ot b e p r oce sse d on lin e .

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Please indicat e y our pr efer ence of int er v iew dat es and t im es. I nt er v iew s ar e t y pically scheduled on t he hour ( for ex am ple: 8: 00, 9: 00, and 10: 00) . I LA w ill at t em pt t o schedule y our int er v iew on one of y our pr efer r ed dat es and t im es, but can not guar ant ee t hat it w ill be able t o do so. To incr ease y our chances of being assigned an

int er v iew dat e and t im e t hat fit y our schedule, and t o av oid delay s in t he pr ocessing of y our r egist r at ion, please choose dat es at least t en day s bey ond t he dat e on w hich y ou m ail t his r egist r at ion for m .

7 . I n d ica t e You r Pr e f e r e n ce of D a t e s Be low :

Examples: 1st Choice	Friday, June 21	Preferred times: 5:00 - 7:00
2nd Choice
	Saturday, June 22	Preferred times: 8:00 - 12:00

N OTE: PLEASE FI LL I N EACH D ATE SPACE W I TH A D I FFEREN T D ATE

8 . Ple a se Re a d Ca r e f u lly . See Fr equent ly Ask ed Quest ions ( FAQs) for m or e infor m at ion .

You r r e g ist r a t ion ca n n ot b e ca n ce lle d . No r efunds w ill be issued. I nt er v iew s ar e conduct ed only in t he Balt im or e, Mar y land, m et r opolit an ar ea. You ar e per m it t ed t o change y our int er v iew dat e and t im e. You m ust m ak e t he r equest for a change at least sev en ( 7) business day s ( M- F) befor e y our scheduled int er v iew dat e. No changes can be m ade if t her e ar e few er t han sev en business day s pr ior t o y our

int er v iew . I LA OPI r egist r at ions ar e v alid for one y ear fr om t he dat e of r eceipt . I f for any r eason y ou can not be pr esent for y our int er v iew or if y ou ar e m or e t han t hir t y m inut es lat e for y our int er v iew , y ou w ill r eceiv e a cr edit of $ 30 . 00 t ow ar d a fut ur e int er v iew session . The r em ainder of y our pay m ent w ill be

r et ained by I LA t o cov er it s ex penses r elat ed t o t he pr ocessing of y our r egist r at ion, t he holding of space, r eser v ing y our int er v iew appoint m ent t im e, and r eser v ing t he t im e of t he I LA OPI pr ofessional

int er v iew er . All r e cor d e d in t e r v ie w s a r e p r op e r t y of I LA, I n c. Please not e t hat t her e is a $ 35 . 00 char ge for r et ur ned check s.

Your int er v iew confir m at ion m at er ials w ill be e m a ile d t o y ou upon t he

pr ocessing of t his com plet ed r egist r at ion for m .

9 . Sig n t h e f ollow in g a g r e e m e n t on t h e sig n a t u r e b la n k .

" I hav e car efully r ead and agr ee t o t he condit ions appear ing on t his I LA OPI r egist r at ion for m concer ning fee pay m ent , non - cancellat ion of r egist r at ion, and ot her policies included in it em 8 abov e. I also v er ify

t hat I am t he per son w hose nam e and addr ess appear on t his r egist r at ion for m . "

1 0 . _____________________________________________	1 1 . __________________________
SI GNATURE	DATE

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