Balticon 41 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: 02/28/07 04/30/07 After/at door Number Total
Adult $45 $50 $58 x_____ $______
Child (age 6-12) $22 $25 $29 x_____ $______
Party Registration fee requires sending email to party@balticon.org
for details of fee and rebate program.
Balticon 40 (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 41
[ ] 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 41 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, 2007.
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
41 Home Page.
Go to the BSFS Home Page.