UW-Madison Advanced Placement Summer Institute
Please print out this form and mail it in with your registration fee.
1. First Name: ________________________________________________________________________________
Last Name: _________________________________________________________________________________
Mailing Address: _____________________________________________________________________________
Street City State Zip
2. Select course you would like to register for:
3. Are you taking APSI for:
Credit (2 credits) $850
4. Do you need assistance locating parking or lodging for the event?
Yes - Parking
Yes - Lodging
Yes - Both Parking and Lodging
5. Do you have any dietary or special accommodations?
Yes, please describe: _____________________________________
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
Lisa Hebgen, UW-Madison Outreach Specialist
Education Outreach and Partnerships Office
225 North Mills Street
Teacher Education Building, Suite 264
Madison, WI 53706-1795