MosCon XXIII Registration Form

Please print and fill out this form.

Name:

Badge name:

Street address:

City, State, & Zip:

Area code & Phone:

E-mail and/or Web address:

I'd be interested in a discussion group on the following topics:

Please send more info on:	Art Show [ ]	Dealers' Room [ ]	Hotel [ ]	Writers' Workshop [ ]
	Gaming [ ]	Volunteering [ ]	Meals [ ]

[Memberships are $25 each until Aug 17, 2001 and $30 at the door (US funds). Day memberships are also available: $12.50 for Friday the 24th, $15 for Saturday the 25th, and $12.50 for Sunday the 26th. Children under 12 are half-price; children under 6 are free.]

Memberships:	____ I wish to purchase:
	____ Full MosCon XXIII memberships           at $25 each	____ Full membership sub-total
	____ Junior MosCon XXIII memberships           at $12.50 each	____ Junior membership sub-total

Meals:	____ I wish to purchase:
	____ Friday dinner tickets           at $17.50 each	____ (Friday meal sub-total)
	____ Saturday brunch tickets           at $15 each	____ (Saturday meal sub-total)
			____ Meal sub-total
Enclosed is a check made out to MosCon XXIII for:			____ Grand total (sum of Full, Junior, Meal sub-totals)

 

Mail to:	MosCon XXIII Registration		For more info:	Charlie Bales, MoxCon XXIII Chairman
	Moscow, ID 83843			E-mail: lonewolfagq2@hotmail.com
	Webpage: http://www.oocities.org/moscow_scifi_con