Student Name:___________________________________________ Grade:___________

School:___________________________________________________________________ 

Parent Name:__________________________________ E-mail:_____________________

Address:__________________________________________________________________ 

Phone:__________________________ Fax:_________________________



Please select a campus
SFU campus
UBC campus



Fees:
One time MathCircles materials fee $45.00


Choose the tuition fee payment option:



One cheque
Dated Sep/1
$495.00


Three cheques
Dated Sep/1, Jan/1, Apr/1
$202.00


Ten cheques
Dated Sep/1 through to June/1
$ 60.60


A single cheque may be used to pay for the materials fee and tuition fee.
Make your cheque(s) payable to Math Potentials Training (MPT). 

Mail the registration form and payment to: 

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

Please read the Regulations and sign below.
Parent signature: _______________________________________________________
Date: _______________________________________________________