LepreCon 27 Membership Form

Name:______________________________________

Badge Name:________________________________

Address:___________________________________

City:__________________________ State:______ Zip Code:____________

Phone:(     )____________ Email:_____________________

Over 18?: ( )yes ( )no

I am interested in:___Displaying in Art Show __Participating in Masquerade

__Dealers Room __Running/Sponsoring a Game __Volunteering to help the convention

Membership rates are:

$35 through  5/01/2001, and $40 at the door
Children 7-12 half price, 6 and under free*
* with adult membership

Why not save yourself $5 at the door? Print this form out using your Web Browser and send along with a check or money order to: LepreCon 27, PO Box 26665, Tempe, AZ  85285 

Administered by Lee Whiteside