RHODE ISLAND

FUTURE PROBLEM SOLVING PROGRAM

2003-2004 REGISTRATION FORM

Team Problem Solving ($65 per team)

______ Junior Division (Grades 4-6) Team(s)

______ Intermediate Division (Grades 7-9) Team(s)

______ Senior Division (Grades 10-12) Team(s)

______ Team(s) @ $65 per team = $ __________

Individual Problem Solving ($35 per student)

______ Junior Division (Grades 4-6) Student(s)

______ Intermediate Division (Grades 7-9) Student(s)

______ Senior Division (Grades 10-12) Student(s)

______ Student(s) @ $35 per student = $ __________

Community Problem Solving ($150 per team)

______ Junior Division (Grades 4-6) Team(s)

______ Intermediate Division (Grades 7-9) Team(s)

______ Senior Division (Grades 10-12) Team(s)

______ Team(s) @ $150 per team = $ __________

Scenario Writing ($35 per student)

______ Junior Division (Grades 4-6) Student(s)

______ Intermediate Division (Grades 7-9) Student(s)

______ Senior Division (Grades 10-12) Student(s)

______ Student(s) @ $35 per student = $ __________

Total Amount Due

$ __________ due for Team Problem Solving

$ __________ due for Individual Problem Solving

$ __________ due for Community Problem Solving

$ __________ due for Scenario Writing

$ __________ DUE FOR ALL PROGRAMS

Please make checks payable to: Rhode Island Future Problem Solving Program

CONTACT INFORMATION

Coach Information

Name:

Home Address:

Home City/Zip:

Home Phone:

Home Fax:

EMAIL ADDRESS (VERY IMPORTANT):

School Information

School Name:

School Address:

School City/Zip:

School Phone:

School Fax:

Billing Information

Billing Agent:

Billing Address:

Billing City/Zip:

Billing Phone:

Billing Fax:

Please send correspondence to: ______ Home

______ School

______ Other (Please provide address)

Please return forms and payment to:

Rhode Island Future Problem Solving Program

C/O Emily Case

67B Pottersville RD

Little Compton, RI 02837

401-741-7663/401-635-4611 eecase@hotmail.com