Balticon 33 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:          3/13/99     3/27/99 or      Number   Total
                                           At the door

Adult                           $40          $45          x_____  $______
   
Child (6-12)                    $20          $23          x_____  $______

Balticon 33 Masquerade Video                 $21          x_____  $______

                                                            Total $______
Payment Options:

[ ] Check or Money Order made payable to Balticon 33
[ ] 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 33 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 27 1999.

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: ______________