Balticon 35 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: 03/15/01 04/30/01 At the door Number Total
Adult $35 $40 $45 x_____ $______
Child (age 6-12) $18 $20 $23 x_____ $______
Balticon 35 Masquerade Video $21 x_____ $______
Total $______
Payment Options:
[ ] Check or Money Order made payable to Balticon 35
[ ] 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 35 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 April 30, 2001.
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 Fundamental
[ ] Volunteering [ ] Costuming Track/Wrkshop
[ ] Filk Contest
[ ] Poetry Trk/Workshop [ ] Other: ______________
Balticon
35 Home Page.
Go to the BSFS Home Page.