OUT-OF-STATE APPLICATION : Middle Grades Program 2004
Print out this application, fill in ALL items, and send
with your payment to the address below.
Name ___________________________________________________________________
Home Address ____________________________________________________________
________________________________________________________________________
Confirm your choice of courses
| Middle Grades Program ____________
|
Lodging: Yes __ No___ If yes, how many nights? ___
Check nights wanted: Su _____ M _____ Tu _____ W _____ Th _____ Fri ____
Your School _____________________________________________________________________
School Address __________________________________________________________________
_______________________________________________________________________________
Phones: Home (____) ____________ Work (____) ____________ Fax (____) ____________
Email ______________________________________________________
Signature __________________________________________________
Please include a check or PO payable to Dept.of Math, University of Washington.
(WA state teachers use WA form.
or Seattle Schools form.)
| Middle Grades Program |
(until 6/15) |
(after 6/15) |
| Registration |
$250 |
$275 |
|
Add Lodging = $50 * no. of nights
|
|
|
| Write TOTAL |
|
|
| 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