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PO Box 1010 |
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Name(s)______________________________ ____________________________________ |
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Address_____________________________ ____________________________________ |
All members on this form must be at the same address. Please circle the name of children for whom you are purchasing a child's admission. |
City _____________________________ State ____________ Zip/Postal _______________ Country _____________ Telephone _________________ Email ______________________ |
Check here if this is a new address:
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Attending | Upgrade | Supporting | Installment | Child's* |
(__) $160 | (__) $125 | (__) $35 | (__) $_____ | (__) $105 |
Please indicate number of each type of membership being purchased in the space provided above. | ||||
I am buying _______ total memberships for a total of $_______. I am paying by (circle one): |
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Card #_________________________________ Exp._________ Name on card ________________________________________ Signature ___________________________________________ |
*Children's admissions do not include publications or voting rights for the Hugo Awards or the 65th Worldcon site selection. Children must accompany an attending member and be 12 years of age or under as of Sept. 6, 2004 This applies only to a child's admission; children who are attending members have full voting rights.
"Worldcon," "World Science Fiction Convention," and "Hugo Awards" are registered service marks of the World Science Fiction Society, an unincorporated literary society. "Noreascon" is a registered service mark of Massachusetts Convention Fandom, Inc.