Balticon 34 Registration Form
Name: ______________________________________ Adult Child (circle one)
Badge Name: ___________________________________
Name: ______________________________________ Adult Child (circle one)
Badge Name: ___________________________________
Name: ______________________________________ Adult Child (circle one)
Badge Name: ___________________________________
Name: ______________________________________ Adult Child (circle one)
Badge Name: ___________________________________
Address: _______________________________________
________________________________________________
City:____________________State:______ZIP:_______ Country:_______________
e-mail:____________________________ Phone: ( )______________
If postmarked by: 06/30/99 12/31/99 03/31/00 At the door Number Total
Adult $30 $35 $40 $45 x_____ $______
Child (age 6-12) $15 $18 $20 $23 x_____ $______
Balticon 34 Masquerade Video $21 x_____ $______
Total $______
Payment Options:
[ ] Check or Money Order made payable to Balticon 34
[ ] Credit card
[ ] Mastercard
[ ] Visa
Card Number: _____________________________ Exp (Month/Year) _________
Signature of Cardholder: x__________________________________
Cardholder name as it
appears on the card: ______________________________________
Card Billing Address: _______________________________________
_______________________________________
City: ____________________State:______ZIP:_______
Country: ____________________
Send this form and payment to:
Balticon 34 Registration
P.O. Box 686
Baltimore,MD 21203-0686
Notes: Children under 6 are free if accompanied by an adult at ALL times.
Mail-in Registration deadline is March 31 2000.
Please copy this page for additional registrations. One address per form,
please.
For more information, check your areas of interest below.
[ ] Handicapped access [ ] Party Registration
[ ] Artist Registration [ ] Writer's Workshop
[ ] Gaming [ ] Young Writer's Contest
[ ] Masquerade [ ] Skills Demonstration
[ ] Programming [ ] Reading is Fundemental
[ ] Volunteering [ ] Costuming Track/Wrkshop
[ ] Filk Contest
[ ] Poetry Trk/Workshop [ ] Other: ______________
Balticon
34 Home Page.
Go to the BSFS Home Page.