Student Name:___________________________________________  Grade:___________

School:___________________________________________________________________  

Parent Name:__________________________________  E-mail:_____________________

Address:__________________________________________________________________  

Phone:__________________________  Fax:_________________________





Math and Art
Aug 21-25
9:00 a.m. to 12:00 p.m.
$150


Math and Nature
Aug 28-Sept 1
9:00 a.m. to 12:00 p.m.
$150





Make your cheque payable to Math Potentials Training Inc. 

Mail the registration form and payment to:              

Math Potentials
P.O. BOX 72001 
SASAMAT, W 10th Ave 
Vancouver, BC V6R 4P2

Please read the Cancellation Policy and sign below.



Parent signature: _______________________________________________________