Pi Mu Epsilon 2012 MathFest Application

PME STUDENT SPEAKER AND DELEGATE APPLICATION FORM

Each PME student speaker must complete a copy of this form. Student Pi Mu Epsilon members who are attending this conference, but are not speakers, should complete this form using the "Type of Application: Delegate" option. Up to five speakers per Chapter may be eligible for reimbursement for at least some of their transportation expenses. One delegate from a Chapter with no speakers may be eligible for partial reimbursement of transportation expenses. Deadline for all applications: 5:00 p.m. EDT Friday, June 8, 2012

* Required

Part 1: All students must complete this section.

Type of Application *

U.S. Citizen? (Federal regulations permit us to offer NSA funding only to U.S. citizens.) *

Student's first name *

Student's last name *

Student's e-mail address *

Student's cell phone number

Student Permanent Address: Street *

Student Permanent Address: City *

Student Permanent Address: State *

Student Permanent Address: ZIP Code *

Student Summer Address (if different from permanent address): Street

Student Summer Address (if different from permanent address): City

Student Summer Address (if different from permanent address): State

Student Summer Address (if different from permanent address): ZIP Code

College or University attended during 2011-2012 academic year *

Degree *

Major *

Intended graduation date *

PME State *

PME Chapter *

Year of initiation into PME *

Month of initiation into PME *

PME Chapter Advisor Name *

PME Chapter Advisor E-mail *

PME Chapter Advisor Telephone Number *

Important Note:

All student speakers and delegates must be members of the chapter at their home institution, which is the one that must nominate them as a speaker or delegate. Since this is an undergraduate conference, all research presented by speakers must have been completed while they were undergraduates. To insure that all work completed as an undergraduate has the chance to be presented, we do permit recently graduated students to present. However, we expect that student speakers and delegates have not completed more than 30 semester hours (or the equivalent) in a graduate program in mathematics (or a related field) prior to July 31, 2012. Note: The Chapter Advisor will be contacted to verify PME membership information.

I will register for MathFest in the PME Speaker/Delegate Category either through the MAA website at www.maa.org/mathfest or using printed materials from the April issue of the MAA Journal, FOCUS. (Very Important: DO NOT register in any other category but this one, and do not purchase a ticket to the PME banquet. Your banquet ticket is included with your PME Student Speaker/Delegate registration fee and will be given to you at the Pi Mu Epsilon student reception on Wednesday, August 1st, at 4:30 p.m.) *

T-shirt size *

Banquet Meal Choice *

Are you planning to give a talk in a PME session? *

No (Skips to part 3)
Yes