2013 Todd Fuller Contest
For Mathematics at NCSU
Team Registration
SCHOOL and COACH INFORMATION
Name of High School: _________________________________________
School Address:
_________________________________________
Coach:
Title and Name:
____________________ ____________________
Telephone:
______________ Email: ____________________
NOTE: email is the primary method of communication for the contest.
All preliminary information to/from team members should go through the Coach
____________________________________________________________________________________________________________
Information on this form is confidential. Winning teams and individuals will be announced, but contact
information will be used only to provide information to contestants and teams.
Nominee 1
Name: _________________________
Address: _________________________
_________________________
E-mail: _________________________
Phone: _________________________
Nominee 4
Name: _________________________
Address: _________________________
_________________________
E-mail: _________________________
Phone: _________________________
Nominee 2
Name: _________________________
Address: _________________________
_________________________
E-mail: _________________________
Phone: _________________________
Nominee 5
Name: _________________________
Address: _________________________
_________________________
E-mail: _________________________
Phone: _________________________
Nominee 3
Name: _________________________
Address: _________________________
_________________________
E-mail: _________________________
Phone: _________________________
Nominee 6
Name: _________________________
Address: _________________________
_________________________
E-mail: _________________________
Phone: _________________________
Alternate Nominee
Name: _________________________
Address: _________________________
_________________________
E-mail: _________________________
Phone: _________________________
MAIL (or email) THIS FORM TO:
Trisha Clinkscales – High School Math Contest
Box 8205, Department of Mathematics
North Carolina State University
Raleigh, NC 27695-8205
Phone: 919-513-2292
Fax: 919-515-0671
Email: tlclinks@ncsu.edu
DEADLINE:
ALL APPLICATIONS MUST BE RECEIVED BY OCTOBER 9, 2013
Changes in team member can be made by the Coach
up to October 14 by contacting Trisha Clinkscales via email or phone
This form is online at http://www.math.ncsu.edu/undergrad/ncsu_contests/