APPLICATION: NWMI Summer Geometry 2009

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

Name _________________________________________

Home Address _________________________________

______________________________________________

Check whether you desire housing.


Geometry Institute July 27-31

Housing on campus?

Yes _____ No ______

School _____________________________________________

School Address _____________________________________

___________________________________________________

Home phone(____) ______________ Work phone(____) _______________ 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 Washington State
$75
$100
Out-of-State (with 5 nights lodging)
$600
$625
Out-of-State (no lodging)
$300
$325
Mail to: NWMI
University of Washington
Department of Math, Box 354350
Seattle, WA 98195-4350 		Phone: (206) 543-1150
Fax: (206) 543-0397
Email: nwmi@math.washington.edu
Web page: http://www.math.washington.edu/~nwmi