Conference Registration

Conference Registration Form

28th Annual Anja S. Greer Conference on Mathematics, Science and Technology Conference to be held June 24 - June 29, 2012.

Registration process: You must complete the following steps to complete your registration.
1 - COMPLETE the registration form.
2 - SUBMIT the form.
3 - PAY ONLINE or MAIL a copy of the receipt with your check for $1,000.00 (USD) to the address provided
on the receipt.

* Indicates Required Fields

Attendee

First Name: *
What first name would you like to appear on your conference badge? *
Last Name: *
Gender: * Male Female

Home Address

Address: *

City:

State/Province: (US/Canada only)
Zip/Postal Code:

Country: *

School Information

School Name: *
Address: *

City:

State/Province: (US/Canada only)
Zip/Postal Code:

Country: *

Contact Information

Home Phone: *
School Phone: * Extension:
Cell Phone:
Email: *
Confirm Email: *
(Conference Correspondence will be sent via email, unless otherwise requested.)

Course Selection

You will register for 2 courses. You are required to select 2 alternative choices in the event that you are not placed in your first choice. Classes are sold on a first-come, first-served basis. For course descriptions click here.

	Preferred	1st Alternative	2nd Alternative
Course I: *
Course II: *

Housing Information

Housing Request: *

I will be commuting to the conference.
I will be staying off-campus.
I am requesting a dorm room.

All dorm accomodations are single-rooms unless you request a roommate. If requesting to share a room with another conference attendee, each participant must include the name of the person they want to share a room with.

Roommate name (if applicable):

Do you have any special mobility needs? *

Yes No

Additional Dorm Requests:

Shirt Size

Small Medium Large Extra Large Extra-Extra Large

Tuesday Evening Events (Optional)

On Tuesday evening of the conference, we plan off-campus events. We buy tickets and plan transportation based on attendee preferences. If you would like to secure a place for an off-campus trip, please select your preference. You will be asked to pay for the trip at the registration desk.

Seacoast Tour Baseball Shop Exeter Boston (self-guided)
Click here for a complete description of our trips.

Payment Information

Payment: *

I will mail my payment (school or personal check)
I will pay via credit card or electronic check
Tuition funded by The Stranahan Foundation

Please type the code listed above in the text box below.