APPLICATION: NWMI Summer Geometry Institute, July 31-August 5, 2005

Print out this application, fill in all items, and send it with your payment to the address below.

Name _________________________________________

Home Address _________________________________

______________________________________________

Housing on campus? (Sunday night through Thursday night) Check One! Yes _______ No ________

School _____________________________________________

School Address _____________________________________

___________________________________________________

Phones:

Home (____) ______________ Work (____) ________________ Fax (____) _______________

Email ________________________________________

Signature ____________________________________

Please include a check or PO payable to Dept.of Math, University of Washington.

  Postmarked June 15 or before Late (after June 15)
Teach in Seattle Public Schools
$0
$0
Teach in Washington State
$275
$300
Out-of-State (with 5 nights lodging)
$525
$550
Out-of-State (no lodging)
$275
$300

Mail to:

NWMI

University of Washington

Department of Math, Box 354350

Seattle, WA 98195-4350



Phone: (206) 543-1915 or 543-1150 Fax: (206) 543-0397

Email: nwmi@math.washington.edu

Web page: http://www.math.washington.edu/~nwmi