2004 AIME Teachers Manual -Form D, alternate AIME Payment Form

FORM D
2004 Alternate AIME Payment Form
Tuesday, April 6, 2004

PLEASE PRINT

School CEEB #: __ __ __ __ __ __

Contest Manager: ______________________________________________________

School Name: _________________________________________________________

School Address:_______________________________________________________

City: ___________________________ State: _________ Zip: ___________________

School Phone #: _______________________________________________________

E-mail: ______________________________________________________________

There will be a processing fee for the second AIME as follows: 1-10 students = $25, 11+ students = $50. We will need your payment before the answer forms can be graded. A special envelope and payment form has been included with your AIME material. All AIME answer forms must be returned by "express mail" so that they arrive in the AMC office by April 9, 2004.

Number of AIME qualifiers who will be taking the alternate AIME on Tuesday, April 6, 2004:

or	1-10 student qualifiers @ $25.00	$ __________
	11+ student qualifiers @ $50.00

Method of Payment:

	Check enclosed (US funds only) made payable and mailed with this form in the BUSINESS REPLY/postpaid envelope provided:
	AMERICAN MATHEMATICS COMPETITIONS University of Nebraska-Lincoln PO Box 880658 Lincoln, NE 68501-9988
	Charge to Visa/Mastercard #: ________________________________________
	Name on card (print): ______________________________________________ Signed: _________________________________________________________ Expiration Date: Telephone:__________________________________________

1-800-527-3690

E-mail: aimequal@amc.unl.edu

Fax: 402-472-6087