BBA/SUMMA Calculator Sales Program Application Form

To apply, print out, fill in, and mail or fax it to:
 SUMMA Program of the MAA
1529 Eighteenth Street, NW
ATTN: Dr. Genevieve Knight, BBA Liaison
Washington, DC 20036
Fax: (202) 483-5450 ph: (202) 319-8473; e-mail: bhawkins@maa.org


Category (check one): School: School District: Professional Development Project:
Name of Applicant:
Size of Target Population
Minority and/or Economically Disadvantaged Percentage:
Contact Person:Title:
Address:
City: State: Zip:
Daytime Phone: Fax: E-mail:
State Tax ID Number:

A copy of your State Tax Exempt Certificate is required to be submitted with PO to avoid payment of taxes.

Unit
(Note all prices are "per calculator/per handheld")		Number of Teacher Packages (10 units each) (X cost per Teacher Package) for Schools/Districts only Number of Single Units (X cost per Single Unit) for Prof. Development Projects only Total
TI-83 Plus, Reconditioned ($45)   
TI-Nspire with Touchpad, Reconditioned ($50)   
TI-Nspire CAS with Touchpad, Reconditioned ($50)   
TOTAL COST
OF ORDER		 $ $  

PERSON CERTIFYING THAT APPLICANT MEETS GUIDELINES
(Superintendent of School District or College/University Administrator)

Name: (Please Print)
Title:
Signature
Date