Capricon XX Registration Form

Pre-Registration Form .
Please print out this registration form and mail in, along with payment, before November 30, 1999. Use a separate form for each person. .		CapriconXX PO Box 60085 Chicago, IL 60660
Name_______________________________________________________ Address_____________________________________________________ City__________________________State___________Zip_____________ Phone (______)_________________ e-mail________________________ Badge Name_________________________________________________ .
[ ] Survivor Premium Membership $49.95 T-shirt size________ .. [ ] Statistic Regular Membership $30.00 . [ ] Genetic Experiment Childcare Membership $50.00 Age at convention_________	Please contact me about... [ ] Parties [ ] Dealers [ ] Gaming [ ] Gophers [ ] Art Show [ ] Gong Show [ ] Critter Crunch [ ] Hall Masquerade [ ] Program Participation [ ] Advertise in Program Book
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