Check all appropriate:  (____)     Enrichment Mathematics for Students of Grade 5-6 Part I

                                                        · 9/10 · 9/17 · 9/24 · 10/1 · 10/15  (9:15 am - 11:45 am)

                                                        Cost:  $ 150

                                        (____)     Enrichment Mathematics for Students of Grade 7-8

                                                        · 9/10 · 9/17 · 9/24 · 10/1 · 10/15  (9:15 am - 11:45 am)

                                                        Cost:  $ 150

                                       (____)     Enrichment Mathematics for Students of Grade 5-6 Part II

                                                         · 10/22 · 10/29 · 11/5 · 11/19 · 12/3  (9:15 am - 11:45 am)

                                                        Cost:  $150

                                        (____)     Enrichment Mathematics for Students of Grade 4

                                                         · 10/22 · 10/29 · 11/5 · 11/19 · 12/3  (9:15 am - 11:45 am)

                                                        Cost:  $ 150

                                       (____)     Enrichment Mathematics for Students of Grade 3

                                                         · 1/7 · 1/21 · 1/28 · 2/4 · 2/11/2006  (9:15 am - 11:45 am)

                                                        Cost:  $ 150

(Please print all information)
Student Name:                                                                                                                       Grade :                       
Address:                                                    Town:                               Zip:                        Telephone:     (        )                                              
E-Mail:                                          @                                School and District:                                                                                                       
Parent Name(s): ____________________________________________________     
If same address and telephone, check here. _________
If different, please indicate:  
Address:                                                                         Zip:                             Telephone:     (        )                                                           

Enclosed is a check to enroll my child in the Enrichment Mathematics program at the Goudreau Math 
Museum.  I have read the program specifications and agree to its contents.                                                                                      
                                                                      
               (Parent Signature)
Return check with this form as soon as possible to insure placement:
                                                Goudreau Museum of Mathematics
                                                Herricks Community Center
                                                999 Herricks Road, Room 202
                                                New Hyde Park, NY  11040
Questions??  Call 516-747-0777.                 Back to program description              Back Home