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www.mathcounts.org/clubreg!
Get an instant email confirmation
without having to wait for processing.

2014–2015 REGISTRATION FORM

Step 1: Tell us about your group. Check and complete only 1 option.
 U.S. school with students in 6th, 7th and/or 8th grade There can be multiple clubs at the
same U.S. middle school, as long as
School Name: _______________________________________________________ each club has a different Club Leader.

 Chapter or member group of a larger organization.

(Can be non-profit or for profit) Examples of larger organizations:
Girl Scouts, Boy Scouts, YMCA,
Organization: _______________________________________________________ Boys & Girls Club, nationwide
tutoring/enrichment centers.
Chapter (or equivalent) Name: _________________________________________

 A home school or group of students not affiliated with a larger

organization. Examples: home schools,
neighborhood math groups,
independent tutoring centers
Club Name: _______________________________________________________

Step 2: Make sure your group is eligible to participate in The National Math Club.
Please check off that all 3 of the following statements are true for your group, to the best of your knowledge:
 My group consists of at least 4 U.S. students.

 The students in my group are in 6th, 7th and/or 8th grade.
 My group has regular in-person meetings.

By signing below I, the Club Leader, affirm that all of the above statements are true, to the best of my knowledge, and that my group
is therefore eligible to participate in The National Math Club. I understand that MATHCOUNTS can cancel my membership at any
time if it is determined that my group is ineligible.
Club Leader Signature: ______________________________________________

Step 3: Get signed up.

Club Leader Name ___________________________________________________ Club Leader Phone __________________________

Club Leader Email _________________________________________________________________________________________________

Club Leader Alternate Email ________________________________________________________________________________________

Club Mailing Address _______________________________________________________________________________________________

City, State ZIP ____________________________________________________________________________________________________

Total # of participating students in club: _____________  Previously participated in MATHCOUNTS.

How did you hear about MATHCOUNTS?  Mailing  Word-of-mouth  Conference  Internet  Email  Prior Participant
For schools only: School Type:  Public  Charter  Private  Home school  Virtual
If your school is overseas: My school is sponsored by  DoDDS. OR  State Department. Country _______________________

Step 4: Almost done... just turn in your form.

Mail, email a scanned copy or fax this completed form to:
MATHCOUNTS Foundation, 1420 King Street, Alexandria, VA 22314
Questions?
Please call the national office at
Email: info@mathcounts.org
Fax: 703–299–5009 703-299-9006