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{\Large\bf Kentucky Section of MAA Annual Meeting\\
Faculty Registration Form}\\
\mbox{}\\
{\large Murray State University, Murray}\\
{\large April 2 - 3, 2004}\\
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Name: \quad \hrulefill\\

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School/Business: \quad \hrulefill\\

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Address: \quad \hrulefill\\

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\hspace*{.75in} \hrulefill\\

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\hspace*{.75in} \hrulefill\\

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Phone: \quad \hrulefill\\

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E-mail: \quad \hrulefill\\

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Check all that apply:\\

\noindent
$\underline{\mbox{\hspace{.5in}}}$\ \
Conference Registration and Dues
\hfill
\$ 25\\

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$\underline{\mbox{\hspace{.5in}}}$\ \
Short Course (Friday afternoon)
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No charge\\

\noindent
$\underline{\mbox{\hspace{.5in}}}$\ \
I would like to give a talk at the meeting.
\hfill
No charge\\
\hspace*{.75in}
Please submit an Abstract Form to John Wilson by March 1, 2004.\\

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$\underline{\mbox{\hspace{.5in}}}$\ \
Friday Banquet
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\$ 14\\

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$\underline{\mbox{\hspace{.5in}}}$\ \
Friday Invited Address
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No charge\\

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$\underline{\mbox{\hspace{.5in}}}$\ \
Aftermath (Friday evening)
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No charge\\

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$\underline{\mbox{\hspace{.5in}}}$\ \
Saturday Invited Address
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No charge\\

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$\underline{\mbox{\hspace{.5in}}}$\ \
Saturday Business Luncheon
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\$ 7\\

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\hspace*{1.5in} TOTAL ENCLOSED \\
\hspace*{1.5in} (checks payable to KY Section of MAA)
    \hfill $\underline{\mbox{\hspace{1in}}}$\\
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\noindent
Deadline for advance registration is March 17, 2004.\\
\quad\quad Note that the  reserved blocks of hotel rooms are
released on March $19^{th}$.\\
Submit to: Daylene Zielinski, Dept of Mathematics, Bellarmine University,
2001 Newburg Road, Louisville, KY 40205, dzielinski@bellarmine.edu



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