Refining 6-12 Mathematics Curriculum and
Instruction
Registration Information
Please print a different form for each registrant. The cost is $185 for this
workshop (including continental breakfast and lunch). Enrollment is limited and
applications are accepted on a first-come, first-served basis. We must receive
your registration form and payment information at least one week before the
date of the workshop.
First Name: _____________________________ Last Name:_______________________
Badge Name (i.e. “James” = “Jim”)_______________________Grade(s)
Taught:______
Home Address:
___________________________________________________________
City: ______________________________________________State:
______ ZIP: _____
Home Phone: ____________________ Email: __________________________________
School:
__________________________________________________________
School Address: ___________________________________City:
__________________
State: _____ ZIP:
School FAX #: ________________ Principal Name:
_____________________________
Math Supervisor Name:
______________________________________________
Please check appropriate box:
Payment method: []
BILLING INFORMATION (REQUIRED)
Please fill in the following if using a Purchase Order for payment and the billing address is different form the school address above:
Billing Department Name:
_____________________________________________________
Address: ____________________________________________________________________
City:
You can FAX this form to (732)445-3477 with a copy of your
Call us at 732-445-2894 or email programs@dimacs.rutgers.edu if you have any
questions.
Cancellation Policy
A full refund will be issued to the appropriate party
if this office is notified at least five (5) business days prior to the
workshop date. If you cancel within five business days, or if neither you nor a substitute attend the workshop without notifying us, no
refund will be issued. All workshops are subject to cancellation for
insufficient enrollment.