MathJam21 Registration

MathJam21

Primary Registration

Registration

How did you hear about this program? (Please be specific) *

(e.g., who/what meeting/location of meeting, etc.)

First Name of Student *

Last Name of Student *

If you prefer not to answer, you may skip this question.

Gender of Student

Female Male Transgender

Birth Date of Student *

(2020-2021 School Year)

Current Grade *

(2020-2021 School Year)

Email of Student *

Primary Street Address of Student *

City *

State *

Postal Code *

Parent Name *

Primary Phone of Parent *

Parent Emergency Phone Number *

Parent Email *

Please describe past involvement w/ Project MEGSSS (e.g., past camp attendance, etc.) *

if first time, please indicate this.

MathJam21 Tuition

MathJam

Half Day (9 AM to noon) - $ 395.00

Total

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

African-American or Black	Asian	Biracial or Multiracial
Caucasian or White	Eastern European	Hawaiian or Pacific Islander
Hispanic or Latino	Middle Eastern	Native American or Alaskan Native
A Race/Ethnicity Not Mentioned Here/Other	Prefer Not To Answer