| Teacher Information: | ||
| Sponsoring teacher's name: | __________________________________________________________ | |
| Home address: | __________________________________________________________ | |
| (please include city, state, and zip code) | __________________________________________________________ | |
| Evening (home) phone number: | __________________________________________________________ | |
| (please include area code) | ||
| e-mail address: | __________________________________________________________ | |
| Names of other teachers attending: | __________________________________________________________ | |
| School Information: | ||
| School name: | __________________________________________________________ | |
| School district: | __________________________________________________________ | |
| School county: | __________________________________________________________ | |
| School mailing address: | __________________________________________________________ | |
| (please include city, state, and zip code) | __________________________________________________________ | |
| School phone and FAX numbers: | (Phone):______________________ (FAX):______________________ | |
| (please include area code) | ||
| Number of students registering from this school: | __________________________________________________________ | |
| Number of teachers registering from this school: | __________________________________________________________ | |
| Number of vehicles requiring a parking pass: | __________________________________________________________ | |
| YES | NO |
May MSU have permission to post your school's name and a link
to your school's web site as a participant? If so, provide the web site address, and sign below, or have the appropriate school official sign before returning the registration form. |
| Web site address: | __________________________________________________________ | |
| Authorization signature: | __________________________________________________________ | |
Sonia Kovalevsky Day
Department of Mathematics and Statistics
Drawer MA
Mississippi State, Mississippi 39762-9715