Registration
Southwestern Section of the MAA and ArizMATYC
Flagstaff, Arizona, April 2-3, 2004
Please submit the form below before March 19, 2004. This will help us to have a reasonable count for rooms, supplies and meals. After that date, meeting registration will still be accepted. Banquet seating is limited, so although you may request banquet tickets later than March 19, 2004, there is no guarantee that seats will be available. You may also download the form for easier entry.
Name (as you want it on name tag): _______________________________________________
Professional Affiliation: ________________________________________________________
Nature: 4 yr college/university __ 2 yr college __ school __ business/government __
Position: Faculty __ Undergraduate Student __ Graduate Student __ Other (specify) __
Memberships (check all that apply): MAA __ AMATYC __ ArizMATYC __ NCTM __
AATM ___ AMS ___ SIAM ___ AWM ___ Other ___
Mailing Address: ______________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Telephone: _____________________________ Fax: _________________________________
e-mail: ____________________________________
Parking Permit Desired ______
Registration Fee $10 __ Banquet (number) _____ at $20 each* Total Enclosed _________
Banquet Entrée: Chicken Provencal ____ Manicotti (vegetarian) ____ Beef Wellington ____
* Banquet fees should arrive by March 19. It may not be possible to honor later requests.
Make checks payable to: MAA Southwestern Section
Send to:
John Hagood
Department of Mathematics and Statistics
PO Box 5717
Northern Arizona University
Flagstaff, AZ 86011-5717