APPLICATION: NWMI Summer Geometry Institute, August 1-6

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

Name _________________________________

Home Address _________________________________

_________________________________

Housing on campus? (Sunday night through Thursday night for no additional charge.)

Yes _______ No ________ .

School __________________________________

School Address ________________________________

_______________________________________________

Phones

Home (____) ______________ Work (____) ______________

Fax (____) ______________

Email ________________________________________

Signature ____________________________________

Please include a check or PO for $150 payable to Dept. of Math, University of Washington.

Mail to:

NMWI
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