REGISTER ONLINE AND SAVE
2017 NATIONAL MATH PENTATHLON® ACADEMIC
TOURNAMENT REGISTRATION & MEMBERSHIP
IN PREPARATION FOR THIS YEAR’S NATIONAL MATHEMATICS PENTATHLON ACADEMIC TOURNAMENT SEASON
WE WOULD LIKE TO MAKE SURE EVERYONE KNOWS HOW TO
SAVE MONEY ON REGISTRATION.
PLEASE MAKE NOTE OF THE FOLLOWING OPPORTUNITIES.
REGISTRATION
TIMELINE
ONLINE
PAPER
Regular Registration
On or Before February 15, 2016
$42
$44
Late Registration
After February 15, 2016
$56
$56
10 Days Prior to Tournament - $80 - Registration CLOSED Thursday through Saturday week of Tournament
NOTE: If you come to tournament without proof of registration we will require a $100 deposit to allow you 1 week to show proof
of payment. Your School Contact Designee will also have registration confirmation of all students registered.
NATIONAL MATHEMATICS PENTATHLON TEAM INFORMATION!
MORE INFO AT: www.mathpentath.org/pdf/mpt_team.pdf
A National Mathematics Pentathlon Academic Tournament TEAM consists of 30 students (and up to 10 alternates) across
5 grade levels, with a distribution of three boys and three girls per grade level. There is not an extra cost for
forming a National Team. However each team is awarded either a First, Second, or Third place trophy or an Honorable
Mention Ribbon in each center. The team with the highest score in the nation receives the National Team Trophy. As
with individual entries, team participants receive awards and recognition based on their individual performance. It is
our long-standing tradition that each Pentathlete™ is awarded for competing in all 5 events!
ALL team members must be registered to compete and the school must send in their Official Team Roster Form
prior to the deadline. If you are planning on sending a team please contact us at (512) 258-5283 and appropriate
registration materials will be forwarded.
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™
39th Annual National Mathematics Pentathlete Tournament Registration
2017 Paper Form ~ REGISTER ONLINE and SAVE ~ www.mathpentath.org
PLEASE PRINT ALL INFORMATION IN BLACK OR DARK INK
Last Name Mailing Address
or
For Office Use Only
Date Reg ____________
Fee ________
Check # ____________________________
REGISTER ONLINE AT www.mathpentath.org
First Middle
City:_________________________________ State: _________ Zip: _____________________
Pentathlete’s Information:
CIRCLE
CIRCLE
Grade: K 1 2 3 4 5 6 7
the Center you will be competing in
Indianapolis
Michigan
Austin
Dallas/FortWorth
PARENTS or GUARDIANS’ Information
CIRCLE
Female
SCHOOL’S Information
District ___________________________________
School ____________________________________
Principal__________________________________
Princ’s E-mail: ____________________________
Phone: ____________________________________
PARENT AGREEMENT
must be PARENTS
completed to participate
✯✯✯
✯✯✯
✯PARENTS
PARENT&&EDUCATORS✯
TEACHER
Game Monitor Information
✯ Supervise/Voluor
nteer ✯
Please initial as indicated.
Please Initial ___________
By entering the National Mathematics Pentathlon Tournament, I release
the Pentathlon Institute, Inc. and its sponsors, organizers, and
affiliates as well as their employees from all claims I shall or may
have against them as a result of my child’s participation in this
event.
Please Initial ___________.
I also agree that the Pentathlon Institute, Inc. and its assignees
may use mine or my child’s name/photo/video taken during this
event and­/or in its preparation to promote the program free and
clear of any claim whatsoever on my part.
Please Initial ___________.
My initials and signature on this form indicate an
understanding and agreement to these statements.
____________________________________
_____ _/______ / ______
Parents or Guardians Signature Date
BIRTHDATE _____ / ______ / ______
CIRCLE PRIOR years competed in National Mathematics Pentathlon Tournament(s)
2010 2011 2012
2013
2014
2015
2016
First Time
Name ______________________________________
E-mail: __________________@_________________
Home Phone: ( _____ ) _______ - ____________
Work / Cell: ( _____ ) _______ - _____________
I have read and understand all rules and directions on this
form. The registered Pentathlete has learned all five (5) games
according to tournament rules. Registration fee is non-refundable
& substitutions are NOT allowed.
Male
Math Pentathlon Teacher’s Information
Name ______________________________________
E-mail: ____________________________________
Home Phone: ______________________________
Work / Cell: _______________________________
Classroom Teacher ________________________
On-Time Registration fee: $44
After February 15: $56
10 Days before Tournament: $80
Parents and educators are needed as Monitors to
Registration fee is non-refundable & non-transferable
make this tournament a success. AT LEAST one adult
Make check payable to and mail to:
Game Monitor is needed for every two Pentathletes.
Pentathlon Institute
The Pentathlon Institute reserves the right to limit
participation from schools/clubs/homes based on 1412 Sadlier Circle E Dr, Indianapolis IN 46239
their volunteer quotas. All Game Monitors should
attend a Volunteers Official Session (VOS). See As a Not-for-Profit Educational Organization we are most
grateful to receive additional support for those who need
the VOS page online for dates and places at: www. financial assistance to enter the tournament. Our 501(c)
mathpentath.org
3 number is 5071.
(Fed I. D. #38-1645063)
Name:___________________________________
Preferred Games to Monitor
1) __________________ 2) ___________________
* If same as above write same*
Email: _________________________________
Phone Number: (____) _____ - __________
***Talk to your school’s Pentathlon Contact
Designee for Game Monitor Assignments***
π16 “WHERE ACTIVE PROBLEM SOLVING & STRATEGIC THINKING COUNTS!”
In addition to the registration fee,
I would like to help others with my
charitable contribution of
Circle: $5 $10 $25 $50 $100
Other______
If paying wiht CC use MC or VISA ONLY
Expiration MM/YY _____/_____ Total $ ______
Signature________________________________
Directions for Paper Mathematics PentathleteTM Registration Form
Register ONLINE and SAVE! ~ 2017 National Mathematics Pentathlon Tournament
®
1 Registration is limited and is arranged on a first-come first-serve basis.
Each year increasing numbers of Pentathletes register
to test their strategic thinking skills. Register EARLY and SAVE! Register ONLINE and SAVE www.mathpentath.org
2 Registration fee is $42 online and $44 mailed-in until the posted registration deadline date.
Fee MUST be received with registration
form. Make check payable to Pentathlon Institute or use VISA or Mastercard to register. REGISTRATION FEE IS NON-REFUNDABLE
& SUBSTITUTIONS ARE NOT ALLOWED.
3 Registration forms will be processed on a first come first served basis until the posted registration deadline for each tournament.
Late registrations, forms postmarked after February 15, 2017, will be processed at $56 on a space available basis.
Registration fee 10 days prior to the tournament is $80 and based on available space. Registration CLOSED Thursday
through Saturday week of Tournament
4 In addition to Division Directors and Game Leaders, A MINUMUM of 1 adult Game Monitor is required for each 2 registered
Pentathletes. It is necessary that Game Monitors attend a Game Monitor Training.
5 Tournament registration forms may be duplicated. Copy all information on both sides of this form.
Registration Forms
can be sent via Fax to (317) 356-6680 with Visa or Master Card payment information.
NATIONAL MATHEMATICS PENTATHLON TEAM INFORMATION!
MORE INFO AT: www.mathpentath.org/pdf/mpt_team.pdf
A National Mathematics Pentathlon Academic Tournament TEAM consists of 30 students (and up to 10 alternates) across 5 grade levels, with a distribution of three boys and three girls per grade level. There is not an extra cost for forming a national team. However each team is awarded either a
First, Second, or Third place trophy or an Honorable Mention ribbon in each center. The team with the highest score in the nation receives the National
Team Trophy. As with individual entries, team participants receive awards and recognition based on their individual performance. It is our long-standing
tradition that each Pentathlete™ is awarded for competing in all 5 events!
ALL team members must be registered to compete and the school must send in their Official Team Roster Form prior to the deadline. If you
are planning on sending a team please contact us at (512) 258-5283 and appropriate registration materials will be forwarded
Mathematics Pentathlon is a Registered Trademark and Service Mark for tournaments and associated services owned and operated through the Pentathlon Institute, a Not-For-Profit Educational Organization. Permission to organize a tournament or any pretournament activities using any of the Pentathlon games must be contracted through the Indianapolis National Headquarters for
the Mathematics Pentathlon. Any requests of this nature should be directed to Dr. Mary Gilfeather, National Program Director, at
(317)356-6284.
Over 112,000 National Mathematics Pentathlon Academic Winners!
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