Michigan Math Circle

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Please complete the following form. Unless otherwise noted, all fields are required.

Student Information First/middle name: Last name: Address Line 1: Address Line 2: (optional) City: State: Zip code: Gender: Date of Birth: (e.g., 03-30-1777) Email: Phone: (e.g., 734-123-4567) Grade: School: Highest math class taken: Most recent math teacher: School’s math club director: (optional)

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