Math Circle Registration Form
| Name of Student(s), grade(s), age(s): | New to the program: yes / no |
Name, address, e-mail and phone number of each parent or guardian. Please Print.
Please number, in order of preference, sessions you could attend:
| Day (Place) | Time | Age Group | Order of Preference | Tuition (not refundable) |
| Tuesday (Harvard) | 3:05 - 4:00 | 4 - 5 yr olds | $225 | |
| Tuesday (Harvard) | 4:05 – 5:00 | 5 – 6 yr olds | $225 | |
| Tuesday (Harvard) | 4:05 – 5:00 | 6 – 7 yr olds | $225 | |
| Tuesday (Harvard) | 5:05 – 6:00 | 7 –8 yr olds | $225 | |
| Tuesday (Harvard) | 5:05 – 6:00 | 8 – 10 yr olds | $225 | |
| Tuesday (Harvard) | 5:05 – 6:00 | 10 – 12 yr olds | $225 | |
| Tuesday (Harvard) | 5:05 – 6:00 | 12 – 16 yr olds | $225 | |
| Wednesday (Harvard) | 5:05 – 6:00 | 7 – 9 yr olds | $225 | |
| Wednesday (Harvard) | 5:05 – 6:00 | 10 – 12 yr olds | $225 | |
| Thursday (Harvard) | 5:05 – 6:00 | 8 – 10 yr olds | $225 | |
| Sunday Sessions (Northeastern Univ.) | 9:00 – 12:00 | 13 – 18 yr olds | $450 |
Please support the Math Circle’s fundraising campaign. We are non-profit and contributions made beyond the tuition fee are tax deductible. Thank you.
Donation amount ___________________________________
Please return this registration form and payment to:
The Math Circle
27 East St.
Southampton, MA 01073
www.themathcircle.org
mathcircle@math.harvard.edu
Well-behaved parents are welcome to attend,
with permission of their children. For further information please e-mail mathcircle@math.harvard.edu.