Balticon 44 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:  02/28/10  04/30/10  After/at door  Number  Total

 Adult               $48        $50       $58                 x_____  $______
   
 Child (age 6-12)    $24        $25       $29                 x_____  $______

Party Registration fee requires sending email to party@balticon.org 
for details of fee and rebate program.

Balticon 43 (last year's) DVD Masquerade Video $20 (incl ship)x_____  $______

Tax deductable donation to BSFS to support Literary Projects   ---->  $______

                                                                Total $______
Payment Options:

[ ] Check or Money Order made payable to Balticon 44
[ ] 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 44 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 May 6, 2010.

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             [ ] Film Festival
[ ] Programming            [ ] Reading is Fundamental
[ ] Volunteering           [ ] Costuming Track/Wrkshop
[ ] Poetry Trk/Workshop    [ ] Other: ______________

Balticon is a service mark of the Baltimore Science Fiction Society a 501(c)3
 non-profit educational organization.


Balticon 44 Home Page.
Go to the BSFS Home Page.