APPLICATION : NWMI Two-Day COURSE 2009
Print out this application, fill in ALL items, and send
with your payment to the address below.
Name ___________________________________________________________________
Home Address ____________________________________________________________
________________________________________________________________________
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 |
$30 |
$30 |
|
|
| Out-of-State (with lodging) |
$250 |
$275 |
|
|
| Out-of-State (no lodging) |
$130 |
$155 |
|
|
| 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