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API 571 Test Registration

Applicants Name:
Exam ID #

_________________________________________

(If previously assigned):

FOR 571 Exams in in 2013-2014


Questions are based on the
API RP 571, Second Edition, Published April 2011

Examination Locations and Dates


Please indicate your preferred exam date and location listed below.

September 25, 2013 (Application Deadline API must receive no later than July 10, 2013)

(Morning Exam Session)


Application deadlines are firm no exceptions will be made.

North America:
Anchorage, AK

Edmonton, AB (Canada)

Oklahoma City, OK

Atlanta, GA

Houston, TX

Philadelphia, PA

Baton Rouge, LA

Los Angeles, CA

St. Paul, MN

Corpus Christi, TX

Oakland, CA

Other Locations:
Abu Dhabi, UAE

Cairo, Egypt

Kuala Lumpur,
Malaysia

Singapore, Singapore

Al-Khobar, Saudi Arabia

Chennai, India

Mumbai, India

United Kingdom
(Contact API for city info)

Bogota, Colombia

Doha, Qatar

Port of Spain, Trinidad

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 571 - 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

Non Member

$225.00

$275.00

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 fiftydollar ($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:

Visa

American Express

Card Number:

Expiration Date:

Name as it appears on card


Signature

MasterCard

_____________________________________________

_______________________________________

Initial Certification Fee


Reschedule / Retest Fee

E-mail address to send receipt:


Check

($75.00)
Late Penalties
Bank Fee (if wired)

Wire Transfer to:

TOTAL SUBMITTED

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

(Reference: Applicants Name and SS-2100-D9200-7110)


Your application will not be processed if this page is not completed.

571_2013 (Revised2)

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