44st Northwest Mathematics Conference Registration
October 13-15, 2005 Red Lion Hotel on the River Portland, Oregon
Registrations must be postmarked no later than October 4, 2005 to qualify for the early registration rate. Registration forms received with later postmarks must pay the late/on-site rate. Any applicable amounts not included will be collected on-site.
Note: Conference momento and Friday lunch provided only to early registrants! Register on the web: http://www.octm.org
Name (as you wish it to appear on name tag)
Job Title School/Institution
Address City
State/Province Zip/Postal Code Phone Number
Work Number Fax Number
This is my (circle one): home address or work address E-mail Address
Grade Level of Interest: PreK-2 3-5 6-8 9-12 Post-Secondary K-12/Admin Other
Are you a speaker at the conference? (One registration per presentation is waived) Yes No
Are you a co-presenter? Yes No
Are you available to be a presider? Thursday Yes No Friday Yes No Saturday Yes No
Friday Lunch Choice: Vegetarian Regular
Thursday Institute ($50 (includes lunch), choose one):
Thursday Institute choice: Alternate Fee:
Circle Lunch choice for Thursday Institute (included): Vegetarian Regular
Saturday Morning Keynote/Breakfast ($25): Fee:
Circle if current member of: OCTM WSMC PSCTM BCAMT
Registration Fee Early (By Oct. 4) Late/On-site (After Oct. 4)
Member of an above organization: $110 $135
Non-member: $130 $155
Full-time Student: $30 $30
Membership (Qualifies registrant for above member fee. Out-of-country add $5 to WSMC and OCTM fees)
OCTM New/Renewal $20 ($10 Student)
WSCM New/Renewal $20 ($10 Student)
PSCTM New/Renewal $10 ($5 Student)
BCAMT New/Renewal $30 (BCTF member, $15 Student)
BCAMT New/Renewal $46 +7% tax=$49.22 (BCTF non-member)
Total enclosed: $
Method of payment (circle one):
Check Check Number (Make checks payable to NWMC):
PO PO Number: PO Contact Phone Number
Billing Address
Credit Card Visa or Master Card (circle one) Expiration Date
Credit Card Account Number
Card Holder’s Name
Card Holder’s Signature
We welcome participants with special needs. Please list any special needs here:
Please direct all registration questions to the University of Oregon Continuation Center:
Phone: 800-280-6218 or 541-346-3537
Fax: 541-346-3545 or 541-346-3509
Mail: NWMC 2005, 1277 University of Oregon, Eugene, OR 97403-1277
Email: nwmcreg@oregon.uoregon.edu
Requests for cancellation received before October 4, 2005 will be subject to a $15 handling fee. No refunds after October 4, 2005.