Mathematical Olympiads

for Elementary & Middle Schools

2154 BELLMORE AVENUE BELLMORE, NY 11710-5645

Founders
Dr. George Lenchner
Selma Landsberg
1979

PHONE: (516) 781-2400

E-MAIL:

FAX: (516) 785-6640

office@moems.org

WEB SITE: www.moems.org

Enrollment Form
Date: _____________
School _______________________________________

# of Renewal(s):____

# of New Team(s):____

District

School Address
City

State/Province

School Phone

Zip + 4

Fax

PICO (Person in Charge of Olympiad Team) ________________________________________________________

PICO E-Mail Address: ________________________________________________________________________
IMPORTANT Fill in the number of teams you are registering in each division
1. Number of Teams
_____ DIVISION E (Gr. 4-6)
_____DIVISION M (Gr. 6-8)
2. Payment:
Check #
Purchase Order #

VISA

Credit Card:

MASTERCARD

DISCOVER

AMERICAN EXPRESS

# ________ ________ ________ ________ Expires ________ Security Code ______

Membership Fee per Team

"Early Bird" Fee

FULL PAYMENT by
June 30, 2015
$99 USD
$125 USD

USA ZIP Codes only

International
*

"Standard" Fee
July 1 thru
October 15, 2015
$109 USD
$140 USD

"Late" Fee
October 16 thru
October 31,2015
$129 USD
$160 USD

We must receive a check (dated on or before 6/30/2015) or your credit card information by this date.
*

P.O.s are not accepted unless accompanied by a check dated on or before 6/30/2015.

Total Amount Enclosed: $___________ for ________ teams.

Use our password-protected website to report and correct all student data and scores, and to receive all contests and practice materials. All
materials will be available at that website. Constantly updated statistics will be available at all times during the contest year. You will need to print
out enough copies of the practice materials and Math Olympiad monthly contests for all team members.

Make P.O. or payment payable to:

Mail this form with P.O. or payment to:

MOEMS

[Teams outside the United States must use credit cards.]

MOEMS - Executive Secretary
2154 Bellmore Avenue
Bellmore, NY 11710-5645

Enrollments accompanied by a PO or a Credit Card may be faxed to (516) 785-6640

Please enroll by October 15. All payments or purchase orders should be received by that date.
If you would like to register a team after October 15, please use the "Late Fee" rate.
Refunds are granted only to schools that withdraw prior to October 15.
A team consists of 35 or fewer students. A team with any members in grade 7 or 8 must be in Division M.
Only fulltime registered students from the same member school or homeschool association are eligible to participate as a Team and receive Team Awards. All other teams,
called District Teams or Institute Teams, are ineligible for Team Awards, and other restrictions apply.

ALL MOEMS MATERIALS ARE COPYRIGHTED. PERMISSION IS GRANTED TO REPRODUCE ONLY FOR CLASSROOM USE.
MATERIALS MAY NOT BE PUBLISHED/REPRODUCED IN ANY OTHER FORM INCLUDING POSTING ON THE INTERNET.
Purchasers Signature indicates agreement (MANDATORY): _______________________________________________________

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