Name: 

     School/Org: 

Mailing Address: 

                 

           City:   State:   Zip: 

  Daytime Phone: 

  Evening Phone: 

            Fax: 

          Email: 

 AFFILIATION
     Yes, I would like to become an Affiliate of the Coalition and receive a coffee mug.
     Please mail your check for $25, along with your Name and Address to...
          NJ Mathematics Coalition
          P.O. Box 10867
          New Brunswick, NJ 08906     

 PRESENTATION
     I would like to obtain a speaker
     for  (organization)
      on  (date)

 WORKSHOPS - NJ MATH STANDARDS - K-4 Teachers
     I would like to be a participant on the one or two dates checked below.
     Further information will be sent promptly.

          Academy South 8/19     Academy North 8/21     Academy Central 8/26
          Academy South 8/20     Academy North 8/22     Academy Central 8/27
                                                              Academy Central 8/28

 GENERAL MEETING
     Please send me more information about the November 21, 1996 meeting.

Comments:

Note: If you prefer, you can print out this Response Form, and mail it to...

NJ Mathematics Coalition
P.O. Box 10867
New Brunswick, NJ 08906