Mathematical
Association of
America

MAA's
Mathematical Study Tour of Peru

July 7 - 19, 2008

REGISTRATION FORM

 
Traveller #1
 
Last NameFirst NameDr/Mr/Mrs
Street
CityStateZip
(Area Code) Day Phone(Area Code) Evening Phone
Email Address
Name for Badge
 
 
Traveller #2
 
Last NameFirst NameDr/Mr/Mrs
Street
CityStateZip
(Area Code) Day Phone(Area Code) Evening Phone
Email Address
Name for Badge
ELIGIBILITY:
Participation is a benefit of membership. Only one membership per household is required.

PAYMENT INFORMATION:

Send completed form with $500 per person deposit (check or money order only) to: (Check payable to the Mathematical Association of America)

Lisa Kolbe
Mathematical Association of America
1529 18th St.,NW
Washington, DC 20036

ACCOMMODATIONS:
Check One:
 I will share a room with __________________________ (roommate's name)
 I am travelling alone & wish to share a room
 I prefer a single room at the supplemental price
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