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 Phone #: ________________________

School FAX #: ________________ Principal Name: ________________________

Math Supervisor Name: ______________________________________________

Please check appropriate box:

Payment method: [] PO   [] Check

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: ___________________________ State: ______ Zip: _________________

You can FAX this form to (732)445-3477 with a copy of your PO or check,

or, mail this form with payment ($185) payable to "Rutgers University -

HSPA Workshops"), to:



CMSCE-Rutgers University, SERC Building Busch Campus, 118 Frelinghuysen Road, Piscataway, NJ 08854



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.