Registration Form
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Chicon 2000, PO Box 642057, Chicago IL 60664
Please Print Clearly:
Name: _______________________________________________________________________
Address: ____________________________________________________________________
City:_________________ State/Country:____________ ZIP/Postal Code:___________
Phone: ________________ E-mail (optional) ___________________________________
As of 01-Oct-1999
Attending membership ...................................... .... $150
Supporting membership ..................................... .... $ 40
I voted - convert from supporting to attending ............ .... $110
Child's Membership ..... Date of Birth ____________________ .... $ 50
(does not receive publications or have voting rights)
Childcare Membership ... Date of Birth ____________________ .... $150
Amount due $___________
Send a check or money order payable to Chicon 2000 to the above address.
Or fill in credit card information below, and mail it to the above address.
[_] MC [_] Visa Number: ____________________________ Exp: ___ /____
Name as it appears on the card: ________________________________________
Signature: _____________________________________________________________
Please send additional information about: [_]volunteering [_]program
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A child-in-tow (no membership, under 9 years of age) must be with parents at all times. Childcare/baby-sitting rates are the same as Attending. Children's (under 13) attending membership rates are $50 (do not receive publications or have voting rights). [Webmaster's note: If you were born on or after 01-Sep-1987, you qualify for the $50 rate.]
If you voted in the site selection balloting in 1997, you have a supporting membership. You can convert this to an attending membership by paying the difference between the current attending rate and the $40 you already spent.
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