AMC 10 & AMC 12 -- 2005 Registration B
amcinfo@unl.edu or 800/527-3690 or FAX 402/472-6087
Date of Exam: Wednesday, February 16, 2005

The Mathematical Association of America
American Mathematics Competitions

AMC 10 & AMC 12 B Contests
email:
 amcinfo@unl.edu Registration Fee -- REQUIRED
fax:
 402/472-6087 (One fee covers both 10B & 12B. Use rate chart below)
phone:
 800/527-3690
1. Early Registration (By Dec. 15) $32
2. Registration (Dec. 16 - Jan. 10) $42
3. Late Registration (Jan. 11 - Feb. 7) $52
} $__________
Registration Record - please print
School CEEB # (6 digits): ___ ___ ___ ___ ___ ___ No registrations after February 7, 2005
After January 15 registrations will be taken by FAX
Contest Manager: 2005 Contest Bundles -- REQUIRED
School Name: (1bundle=10 exams & 10 answer forms)
AMC 10

Contest bundle of 10,

#_______ @ $13/bundle $__________
Solutions Set of 10 (optional) #_______ @ $ 6/set $__________
AMC 12

Contest bundle of 10,

#_______ @ $15/bundle $__________
Solutions Set of 10 (optional) #_______ @ $ 6/set $__________
School Street Address:
City: State: Zip:
School Phone #: ____/_____-__________
BILLING ADDRESS (if different from school): Contests in other languages/formats please check here:

French (bundles of 10)
AMC 10 All or# Bundles____
AMC 12 All or# Bundles____
Spanish (bundles of 10)
AMC 10 All or # Bundles____
AMC 12 All or# Bundles____
Braille & Large Print Contests are priced individually
(Requests should be received by January 10)
AMC 10 Braille #_____ AMC 10 @ $1.30/each $__________
AMC 12 Braille #_____ AMC 12 @ $1.50/each $__________
AMC 10 Large Print #_____ AMC 10 @ $1.30/each $__________
AMC 12 Large Print #_____ AMC 12 @ $1.50/each $__________
plus .........................$7.00 shipping $__________
City: State: Zip:
Phone #: ____/_____-__________
E-mail (for sending results) Please Print Clearly:
(Circle appropriate responses, below)
School Type:
Public
Home
Private
 First Class/UPS Shipping & Handling REQUIRED
United States Schools
Military Schools:		 $12.00 flat fee } $__________
Canadian Schools $30.00 flat fee
International Schools:
(a $63 maximum)		 .# ____@ $ 7.00 per bundle
OPTIONAL (Foreign Schools Only): $__________
Send results by Express Mail for a $25 fee
Grades:
PreK
K
1
2
3
4
5
6
7
8
9
10
11
12
13
School Size:
0-200
201-500
501-1,000
1,000 +

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.
AMC 10/12 MATH CLUB PACKAGE:
Study Guide, Web materials, see brochure. Sent separately; available Summer 2004
$15/package, plus $7.00 shipping = $22.00
$__________
Check
P.O. # ___________
Visa
Master Card
TOTAL ORDER -- PAID IN US FUNDS $__________

Terms - Payment in U.S. Funds only.

Make checks payable to:
American Math Competitions
All orders Non-Refundable once shipped.
Mail along with your payment or Purchase Order to:

MAA American Mathematics Competitions
ATTN: AMC 10/12 Registration
P.O. Box 81606
Lincoln, NE 68501-1606
VISA/MC # :
Exp. Date: _____________
Name (Please Print):
(Please give an address for mailing the charge receipt in "Billing Address" above)

The AMC Web Site was last updated on 11/29/2004