MATH WORKSHOPS - REGISTRATION FORM

August 23-27, 2010

INSTRUCTIONS: Please print, complete and return this registration form before August 20,
2010. Do not forget to include a non-refundable cheque for the amount of $200, payable to
the University of Ottawa. If you register at the University of Ottawa for the fall 2010 session,
75% of the workshop fee will be deducted from your tuition fees for the fall 2010 session.

You can register by mail or in person at the following address:

Office of Undergraduate Programs, Faculty of Science, Gendron Hall

30 Marie-Curie, Room 172, Ottawa, Ontario K1N 6N5

Surname _________________________________ Given names_______________________

Student Number __________________________

Mailing address _____________________________________________________________

__________________________________________________________________________

Mailing address telephone ____________________Work telephone ____________________

Email ______________________________________________

Admitted to (Faculty or Program) _____________________________________________

You will receive by email confirmation of your registration to the workshop before August
20.

Student signature _____ Date

Space reserved for Faculty use