PME Application Form
Return to the Department of Mathematics, UH 2040, or to Dr. Ivie Stein, Jr., UH 2020C.
Phone Numbers: 419.530.2994, 419.530.2568, and 419.530.2232.
E-mail: istein@utnet.utoledo.edu
Name: ____________________________________________________________
(Give your name as it should appear on the certificate.)
Address: _____________________________________________________________
(Permanent mailing address for Pi Mu Epsilon Journal.)
College and Department: ________________________________________________
Year of Graduation: __________ Student ID #: ______________________________
Local address and phone number: _____________________________________
________________________________________________________________
________________________________________________________________
Will this address be the same next year? ___________
E-mail address: ________________________________________________________
For regular and associate membership, an initiation fee of $24.00* is required for the certificate and
one year subscription to the journal. Please make checks or money orders payable to Pi Mu Epsilon.
Return payment to the Mathematics Department Office, UH 2040. The Pi Mu Epsilon Official Pin
is available for an additional $20.00*.
For regular membership (undergraduate and graduate students), please give the following information:
General GPA: _________ GPA in Mathematics: ________
Math courses taken and grades: _______________________________________
________________________________________________________________
________________________________________________________________
*As of February, 2004. Fee schedule is subject to future change.