REGISTRATION FORM 2023 - 2024
Mathematical Olympiads for Elementary & Middle Schools
2154 BELLMORE AVENUE BELLMORE NY 11710-5645
Phone: (516) 781-2400 FAX: (516) 785-664
e-mail: office@moems.org web site: www.moems.org
Enrollment Form 2023-2024
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School Name
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Street Address
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City
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State
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ZIP
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Country
List
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School Phone
PICO's Mobile
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PICO's Name
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PICO's email address
Team Classification
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Public
Private
Parochial
institute
DODDS
Home School
District
Billing Information
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Billing Information (This section MUST be completed if payment is from a different billing address)
Billing Info Is Same As School Info
Billing Name
Street Address
City
State
ZIP
Country
List
Accounts Payable Phone
Accounts Payable Email
Teams
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Number of Teams in each Division: (35 student maximum per team)
Division E (grades 4-6)
Division M (grades 6-8)
Fees per Team
Invoice Payment Terms:
Net 30
USA/Canada/Mexico
International
Early Bird Fee
Full Payment By:
7/31/23
$175.00
$215.00
Standard Fee
Registration by this date:
10/15/23
$200.00
$240.00
Late Fee
Registration by this date:
10/31/23
$250.00
$290.00
Last Chance
Registration by this date:
11/1/23
$300.00
$340.00
Payment
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Check
Purchase Order
Visa
Master Card
Check #
PO #
