Delaware Secondary School Mathematics League

Sponsored by

DCTM - Delaware Council of Teachers of Mathematics, Inc.

Invitational and Banquet Registration Form – Grades 10-12
Tuesday, April 25, 2017

Coaches, please complete this form by printing all information legibly. Fax the original of this registration form to Thomas J. Koliss and then submit a copy to your business office for payment. The fax number, address and e-mail information are given below. School registrations must be received no later than April 10, 2017. Payment must be received no later than April 15, 2017. Confirmations for school registrations and payment will be e-mailed.

School Name: ______Math League Region #: ______

School Phone: ______Fax: ______

Team Name: ______Coach: ______

Team Name: ______Coach: ______

At Large Participant: ______

At Large Participant: ______

At Large Participant: ______

At Large Participant: ______

At Large Participant: ______

Coach accompanying At Large participants: ______

COSTS:

Number of teams (5 students and 1 coach) ______at $100 / team = ______

Any additional team members from teams in line above ______at $17 / person = ______

Number of At Large participants ______at $17 / person = ______

One At Large coach ______at $17 / person = ______

Number of additional coaches ______at $17 / person = ______

(Provide the names of any additional coaches.)

Total Due: ______

Make checks payable to DCTM, Inc. Purchase Orders will NOT be accepted. DCTM’s State of Delaware vendor number is 0000141875. Payment should be processed from this registration form; invoices cannot be provided. If you are paying through the State accounting system, please enclose a note or put some notation on your check so that your school will receive proper credit. State checks generally have only the school district name on them. If you have any questions, please e-mail or call Thomas J. Koliss. Thank you!

Thomas J. Koliss Tel: 302-631-4700 x 14422

Math League / Grades 9-12 Fax: 302-454-2155

4508 Sandy Drive E-mail:

Wilmington, DE 19808

School registrations must be received no later than April 10, 2017.

Payment must be received no later than April 15, 2017.