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					                   UW-Madison Advanced Placement Summer Institute

           Please print out this form and mail it in with your registration fee.

 1. First Name: ________________________________________________________________________________

     Last Name: _________________________________________________________________________________

     Email: ________________________________________________________________________________________

     Organization: ________________________________________________________________________________

     Mailing Address: _____________________________________________________________________________
                              Street                     City              State            Zip

 2. Select course you would like to register for:
       Biology
       Calculus AB/BC
       English Language
       English Literature
       French
       Psychology
       U.S. Government
       U.S. History

3. Are you taking APSI for:
       Credit (2 credits) $850
       Non-credit $750

4. Do you need assistance locating parking or lodging for the event?
       Yes - Parking
       Yes - Lodging
       Yes - Both Parking and Lodging
       No

5. Do you have any dietary or special accommodations?
       Yes, please describe: _____________________________________
       No

ASPI Fees – Please return this form by May 15, 2012 along with the Institute
registration fee (check only) payable to the UW-Madison Education Outreach and
Partnerships office.

Lisa Hebgen, UW-Madison Outreach Specialist
Education Outreach and Partnerships Office
225 North Mills Street
Teacher Education Building, Suite 264
Madison, WI 53706-1795

				
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