Printable Registration Form: NWMI Summer Program 2011

First, fill out the ONLINE REGISTRATION FORM. Then print out this form, fill in all items, and send it with your payment to the address below.

Name _________________________________________
Home Address _________________________________
______________________________________________

Home phone(____) ______________ Email (including summer) ________________________________________

Signature ____________________________________

PLEASE CIRCLE THE ITEM IN THE TABLE that you are registering for.

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

Five-Day Program (Summer Geometry Institute Postmarked June 25 or before Late (after June 25)
Program with lunch but no lodging.
$175
$205
Program with lodging included (5 nights)
$425
$460
Two-Day Program (ORIGAMI or GAMES - CIRCLE ONE) Postmarked June 25 or before Late (after June 25)
Program with lunch but no lodging.
$75
$110
Program with lodging included (one night)
$135
$170
BOTH Two-Day Programs (ORIGAMI and GAMES) Postmarked June 25 or before Late (after June 25)
Program with lunch but no lodging.
$150
$185
Program with lodging included (3 mights)
$335
$370
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