REGISTRATION FORM 2023 - 2024
Mathematical Olympiads for Elementary & Middle Schools
2154 BELLMORE AVENUE BELLMORE NY 11710-5645
Phone: (516) 781-2400 FAX: (516) 785-6640
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
PICO's email address 2
PICO's email address 3
Team Classification
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Public
Private
Parochial
institute
DODDS
Home School
District
District (Click this button ONLY if payment is being
made by the School District Business Office.)
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 Name
Accounts Payable Phone
Accounts Payable Email
Shipping Information
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Location to receive awards & certificates.
Shipping Info Is Same As School Info
School Name
Street Address
City
State
Zip
Country
List
Teams
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Note: 1 Team can only have maximum of 35 students
How many teams for Division E (grades 4-6)
How many teams for Division M (grades 6-8)
Fees per Team
Invoice Payment Terms:
Net 30
USA/Canada/Mexico
International
Early Bird Fee
Full Payment By:
7/31/2023
$175.00
$215.00
Standard Fee
Registration by this date:
10/15/2023
$200.00
$240.00
Late Fee
Registration by this date:
10/31/2023
$250.00
$290.00
Last Chance
Registration by this date:
11/1/2023
$300.00
$340.00
Payment
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Check
Purchase Order
Visa
Master Card
ACH/EFT
Check #
PO #
