Balticon 48 Registration Form - Mail-in Registration deadline is May 4, 2014.

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: (      )________________
(Please copy this page for additional registrations. One address per form, please.)

If postmarked by:   02/28/12   04/30/12   After/At door   Quantity     Total

Adult                 $55         $60          $65         x ____    $_________

Child (age 6-12)      $27         $30          $33         x ____    $_________

Balticon 47 (2013) 3-DVD set, including Masquerade, Special Events and select 
     Film Festival entries $30 (includes tax & shipping)
                                                           x ____    $_________

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

                                                             Total   $_________
Payment Options:
	[   ] Check/Money Order payable to Balticon   [   ] 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 48 Registration
                                           P.O. Box 686
                                           Baltimore, MD 21203-0686

Notes: Children under 6 are free if accompanied by an adult at ALL times.

For more information, check your areas of interest below.

[   ] Handicapped access    [   ] Party Registration               [   ] Young Writer's Contest
[   ] Open Staff Positions  [   ] Artist Registration              [   ] Writer's Workshop
[   ] Artist Alley          [   ] Masquerade                       [   ] Film Festival         
[   ] BSFS Books for Kids   [   ] Volunteering                     [   ] Costuming Track/Wrkshop
[   ] Fan Tables            [   ] Poetry Track/Workshop            [   ] Becoming a Program Participant
[   ] Sponsorship           [   ] BSFan Advertising                Other: _____________________________

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

Balticon 48 Home Page                        Go to the BSFS Home Page.