APPLICATION : NWMI SHORT COURSE 2008

Print out this application, fill in ALL items, and send with your payment to the address below.
Name ___________________________________________________________________
Home Address ____________________________________________________________
________________________________________________________________________
Session A. August 4-5
TI Inspire______


Housing on campus? Check One! Yes _______ No ________ Gender (for housing) M __ F __
Your School _____________________________________________________________________
School Address __________________________________________________________________
_______________________________________________________________________________
Phones: Home (____) ____________ Work (____) ____________ Fax (____) ____________
Email ______________________________________________________
Signature __________________________________________________

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

 
ONE Course
  (until 7/4) (after 7/4)    
Teach in Washington State $40 $40    
Out-of-State (with lodging) $250 $250    
Out-of-State (no lodging) $130 $130    
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