REGISTRATION FORM
Fall 2005 Meeting -- Northeastern Section of the MAA
November 18-19, 2005,  University of New Hampshire, Durham NH

Please Pre-register!  On-line registration is NOT available.  However, you can print out this form and mail it to the address below.  Please send the form so that it arrives by Thursday, November 10, 2005.  Checks should be made to: NES/MAA. If you have questions about registration, you can also contact Eric Grinberg at grinberg@unh.edu .  You should mail this pre-registration form to :

Last Name___________________________________  First Name _________________________  MI ______

If you prefer another name on badge please indicate here:________________________________

Institutional Affiliation ______________________________________________________________________

Mailing Address __________________________________________________________________________

City _____________________________________  State ________  ZIP __________  Country  ____________

Daytime Phone Number _____________________________ FAX number __________________

Email Address  __________________________________________________________

Please check box that applies to you:  
Two-year college faculty,      Four-year college faculty,      University faculty,

 High School teacher,            Business/industry/government,       Retired,

 Undergraduate student,       Graduate student,      Unemployed (but not retired)		                  
Pre-registration fee:
      MAA Member     $25.00, 
      Non-Member       $30.00
      Student or unemployed     $10.00		  $
Friday Banquet:
     $27.00 per person (Be sure to include any guests.) 
      Please indicate special meal needs/allergies:______________________________		  $
Saturday Luncheon:
      $8.00 per person (Be sure to include any guests.)
      Please indicate special meal needs/allergies:______________________________		  $
TOTAL PAYMENT (Checks should be made payable to: NES/MAA.)
 		  $
Section NExT:
     There is no fee for Section NExT activities for Fall 2005.
     Are you attending Section NeXT on  Friday?                                       (    ) Yes      (    ) No      
      Are you attending the Section NeXT lunch on Friday?
                      (   )  Yes       (    )  No		  

You may register at the meeting if you wish; however, it would facilitate the organization of the meeting if you pre-register by mail and it will save you money in that on- site registration fees are five dollars more than pre-registration fees.  In any case, meals cannot be guaranteed unless reservations are received by Thursday, November 10, 2005.  It may not be possible to buy tickets to the banquet or lunch at the meeting.  Spouses and guests are welcome at all meals, but they must be included in the pre-registration count.                                                                                         

Return to NES/MAA Fall 2005 Local Arrangements.