2004 AMC 10/12 Brochure - Registration Form B, for February 25, 2004

AMC 10/12
Form B - for Wednesday, February 25, 2004
2004 REGISTRATION FORM
The Mathematical Association of America / American Mathematics Competitions
Questions? EMAIL amcinfo@unl.edu --- 800/527-3690 --- FAX 402/472-6087
PLEASE NOTE: Except for this brochure, all materials are copyrighted. DUPLICATING IS NOT PERMITTED.

please print

School CEEB# (ETS, See section IV, 6 digits): ___ ___ ___ ___ ___ ___			BILLING ADDRESS (if different from school):
Contest Manager: ___________________________________			___________________________________
School Name: ___________________________________			___________________________________
School Street Address: ___________________________________			___________________________________
City: __________________	State: _____	Zip: _________	City: _________________	State: ______	Zip: ___________
School Phone #: _____/______-____________			Phone #: _____/______-____________
E-mail (for sending results) Please Print Clearly: _______________________________________________________________________
School Type (circle one):			Grades:
Public	Home	Private	5 6 7 8 9 10 11 12 13

PAYMENT OPTIONS (Do not send payment alone. The Registration Form must be included with your payment option) Checks sent without appropriate registration information cannot be processed and will be returned to sender.
Check P.O.# __________________ Visa Master Card
Terms - Payment is U.S. Funds only. Make checks payable to: AMERICAN MATH COMPETITIONS
CREDIT CARD INFORMATION:	(Please give an address for mailing the charge receipt in "Billing Address" above)
Visa/MC Card #: _________________________________________________
Cardholder Name (please print):
Exp. Date:

REGISTRATION FEE (One fee covers both 10B & 12B. Use rate chart below) REQUIRED (No registrations after February 15, 2004)
	Discount Registration, By Dec. 15	$32	$ __________
	Registration, Dec. 16 - Jan. 15	$42
	Late Registration, Jan. 16 - Feb. 15	$52 ( fax please)
	After Jan. 15 registrations will be taken by FAX
AMC 10	Contest Bundles of 10 exams and answer forms	#_________ @ $ 13/bundle =	$ __________
AMC 10	Solutions Sets of 10 pamphlets (optional)	#_________ @ $ 6/set =	$ __________
AMC 12	Contest Bundles of 10 exams and answer forms	#_________ @ $ 15/bundle =	$ __________
AMC 12	Solutions Sets of 10 pamphlets (optional)	#_________ @ $ 6/set =	$ __________
Shipping - (First Class/UPS Shipping and Handling:) REQUIRED. (choose 1 below)
	United States and Military Schools:	$ 12.00 flat fee	$ __________
	Canadian Schools: (Shipping by DHL)	$ 15.00 flat fee
	Foreign Schools:.	# _________@ $ 5.00 per bundle (with a $60 maximum)
OPTIONAL: (Foreign Schools Only): The MAA AMC office will send results by Express Mail for a $25 fee			$ __________
TOTAL ORDER - MUST BE PAID IN US FUNDS			$ __________

Mail along with your payment or Purchase Order to: MAA American Mathematics Competitions ATTN: AMC 8 Registration P.O. Box 81606 Lincoln, NE 68501-1606	For Contests in other languages and formats please check here:
	French ( bundles of 10)	All	or # Bundles____
	Spanish (bundles of 10)	All	or # Bundles____
	Braille (individual)		# Contests____
	Large Print (individual)		# Contests____

Cover

Table of Contents

Text

Registration
Form A

Registration
Form B

AMC 10 Questions

AMC 12 Questions