Greater Dane County Talented & Gifted Network
Registration and Fee Statement 2013-2014DUE OCTOBER 1, 2013
District or School or Organization
Primary District/Org Contact Person
Address
City, State, Zip
Work Phone
Fax Number
E-Mail Address
MEMBERSHIP DUES: $75.00
PLEASE COMPLETE INFORMATION FOR EACH
PROGRAM IN WHICH YOUR DISTRICT WILL PARTICIPATE
YAHARA RIVER WRITERS (Grades 5-8)
Check here if contact person is the same as the “Primary District Contact Person”
If different, complete:
Yahara contact name
Contact e-mail
Contact phone
FEE: Check one (See Yahara “District Allotments and Fees” for allotted number of entries)
$60, 2-3 entries for each grade/category
$90, 4-5 entries for each grade/category
$120, 6-7 entries for each grade/category
$150, 8-10 entries for each grade/category
TOTAL FEE FOR YAHARA $
MATH MEETS (Grades 5/6 and 7/8)
FEE: $45 per team (See Math Meet “District Allotments” for number of teams you may register)
Grades 5/6: Number of teams @ $45 each = $
Check here if contact person is the same as the “Primary District Contact Person”
If different, complete:
Math Meet 5/6 contact name
Contact e-mail
Contact phone
Grades 7/8: Number of teams @ $45 each = $
Check here if contact person is the same as the “Primary District Contact Person”
If different, complete:
Math Meet 7/8 contact name
Contact e-mail
Contact phone
TOTAL FEE FOR MATH MEETS$
DISTRICTName of Primary Contact
HAIKU (Grade 4)
Check here if contact person is the same as the “Primary District Contact Person”
If different, complete:
Haiku contact name
Contact e-mail
Contact phone
FEE: $20 per district
TOTAL FEE FOR HAIKU$
MATH 24 CHALLENGE (Grades 4-8)
FEE: $15 per group of 3 (See Math 24 District Information for number of groups you may register)
Grade 4: groups @ $20 = $
Check here if contact person is the same as the “Primary District Contact Person”
Math 24 Gr 4 contact name
Contact e-mail
Contact phone
Grade 5: groups @ $20 = $
Check here if contact person is the same as the “Primary District Contact Person”
Math 24 Gr 5 contact name
Contact e-mail
Contact phone
Grade 6: groups @ $20 = $
Check here if contact person is the same as the “Primary District Contact Person”
Math 24 Gr 6 contact name
Contact e-mail
Contact phone
Grade 7: groups @ $20 = $
Check here if contact person is the same as the “Primary District Contact Person”
Math 24 Gr 7 contact name
Contact e-mail
Contact phone
Grade 8: groups @ $20 = $
Check here if contact person is the same as the “Primary District Contact Person”
Math 24 Gr 8 contact name
Contact e-mail
Contact phone
We are willing to host at grade(s) 4 5 6 7 8
TOTAL FEE FOR MATH 24 CHALLENGE $
DISTRICTName of Primary Contact
FINAL FEE STATEMENT
Transfer totals from the other sections into each box. The Grand Total will change to reflect your total fee.
Membership / $75.00Yahara / $0.00
Math Meets / $0.00
Haiku / $0.00
Math 24 / $0.00
GRAND TOTAL / $ 75.00
REGISTRATIONS MUST BE RECEIVED BY OCTOBER 1, 2013
Please submit on time!!
- Save the document with your district name and the 1314 at the end. (Albany 1314, Belleville 1314, Cambridge 1314, etc.)
- Print a copy for your business office. Be sure your business office has the correct address for the treasurer, listed below.
- Ask your business office to send a check rather than a PO. The check can arrive AFTER October 8.
- Attach your form in an email to Kitty Ver Kuilen:
Provide this address to your business office for the checks:
GDCTGN
c/o Kristy Champion, Treasurer
1633 Keeler Ave.
Beloit, WI 53511