Student Name:___________________________________________  Grade:___________

School:___________________________________________________________________  

Parent Name:__________________________________  E-mail:_____________________

Address:__________________________________________________________________  

Phone:__________________________  Fax:_________________________


 MathClick Workshop: Sat, September 2, 9:00 AM-4:00 PM  ($67)


Make your cheque payable to Math Potentials Training Inc. 

Mail the registration form and payment to:              

Math Potentials
P.O. BOX 72001 SASAMAT
Vancouver, BC  V6R 4P2

Please read the Cancellation Policy and sign below.



Parent signature: _______________________________________________________