Please pre-register! On-line registration is NOT available. Please send this registration form so that it
arrives by Friday, November 3rd. You must pre-register for the
meeting and pay all charges by Friday, November 3rd to be guaranteed a place at the meals. If you have questions about registration, send email to molitiernoj@sacredheart.edu
Mail this form to:
Dr. Jason Molitierno - NES/MAA
Department of Mathematics
Sacred Heart University
5151 Park Avenue
Fairfield, CT 06825-1000
Last Name_______________________________________________________
First Name ____________________________________________ MI ______
If you prefer another name on badge, indicate here: ______________________
Institutional Affiliation _____________________________________________
Mailing Address __________________________________________________
________________________________________________________________
City _____________________________________ State _________________
ZIP __________ Daytime Phone Number _____________________________
Email Address ___________________________________________________
Please check one that applies to you:
| _____ |
University Faculty | _____ |
High school faculty/administrator | _____ |
Graduate Student |
_____ |
Four-year college faculty | _____ |
Business/Industry/Government | _____ |
Undergraduate |
_____ |
Two-year college faculty | _____ |
Retired | _____ |
Unemployed |
Pre-registration fee: MAA Member $25 |
$ _______ |
Friday Banquet: $27 per person (Be sure to include any guests.) |
$ _______ |
Saturday Lunch: $12 per person (Be sure to include any guests.) |
$ _______ |
Total Payment (Make checks payable to NES/MAA)
|
$ _______ |
Section NExT: All full-time untenured faculty are welcome, and there is no fee for Section NExT activities. Are you attending Section NExT on Friday? _____Yes _____No
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