1. First Name:
2. Last Name:
3. Affiliation: (for nametag)
4. Address:
5. City, State, Zip:
6. Email:
7. Phone:
8. Fax:

1. College or university faculty
2. Business/Industry/Government
3. Student
4. Retired

1. Regular
2. Vegetarian
3. Vegan

Please indicate whether you are interested in a hike in Zion National Park. (This will occur on Saturday, October 13, all day.)

1. Interest in Hike? Yes No

General Registration:

• before or on 9/7/2012, $120 ($60 for students or retired/unemployed mathematicians)

• after 9/7/2012, $140 ($70 for students or retired/unemployed mathematicians)

Participant buffet is included in registration (additional guest buffet - $25)

You may also mail your payment to:
Dr. Derek Hein
ELC 418
Southern Utah University
Cedar City, UT 84720

Overseas participants can also elect to pay upon arrival. Please email Derek Hein at hein@suu.edu if you intend to do so.

Payment must be received after submitting this registration for it to be complete. Immediately after this, you will be taken to a page to process your payment.