Name (Last) ___________________________(First)_______________________
Street ______________________________________________________________
City _______________________________ State ___________ ZIP___________
School or Business Affiliation _______________________________________
Phone _____________________
Email Address ________________________________________________________
Registration [ ] Regular Member: $25.00 ($30.00 on site) _________
[ ] Retiree: $10.00
[ ] Student Presenters: $.00
[ ] Students from Institutional Sponsors: $0.00
[ ] Student Math contest participant: $0.00
[ ] Student other than above: $10.00
Firday morning field trip [ ]
(Donate $3.00 at Dana-Thomas House)
Friday Evening Reception and Banquet ($25.00) _________
Buffet which includes carved prime rib, Grecian chicken
breast, and vegitarion lasagna
Additional special dietary needs ______________________
Saturday box lunch ($7.00) _________
($0.00 for NExT Participants)
Saturday afternoon - Assesment Forum Continued [ ]
($0.00 but pre-registration requested)
TOTAL _________
Please send this registration form and your check made payable
to the ISMAA to
Jon Johnson
Mathematics Department
Elmhurst College
Elmhurst, Illinois 60126
February 4, 2003