WA-STATE APPLICATION : NWMI MINICOURSES 2005

Print out this application, fill in ALL items, and send with your payment to the address below.
Name ___________________________________________________________________
Home Address ____________________________________________________________
________________________________________________________________________
Check your choice of courses (max of ONE per session):
Session A. August 1 - 2
Fourth Dimension ______
Counting & Number Patterns _____ 		Session B. August 3 - 4
Tessellations _______

Housing on campus? Check one. Yes _______ No ________ .

(One night included for one course, three nights for two at no additional charge.)

Your School __________________________________________________

School Address _______________________________________________

_____________________________________________________________

Phones: Home (_____) ________________ Work (_____) _______________ Fax (_____) ________________

Email ________________________________________________

Signature ____________________________________________

Please include a check or PO payable to Dept.of Math, University of Washington.
OUT-OF-STATE teachers use OS form.

  ONE Course
(until June 15) 		ONE Course
(after June 15)

TWO Courses
(until June 15)

TWO Courses
(after June 15)
Teach in Washington State $125 $150
$250
$300
Teach in Seattle Public Schools $0 $0 $0 $0
Mail to: NWMI
University of Washington
Department of Math
Box 354350
Seattle, WA 98195-4350 		Phone:
(206) 543-1915		 Fax:
(206) 543-0397		 
Email: nwmi@math.washington.edu
Web page: http://www.math.washington.edu/~nwmi