Capricon 25 - Mad Scientists - Show & Tell Form

Entry Number _________(for office use only)

(* Indicates required field)
* Name _____________________________________________________

* Address ___________________________________________________

* City_________________________*State__________*Zip____________

Phone Number ______________________________________________

* Email Address _____________________________________________

* Entry Type (select one)
[.. ] Adult/Individual
[.. ] Adult/Group
[.. ] Youth (12 and under)/Individual
[.. ] Youth (12 and under)/Group

Emcee Script (attach additional sheet if necessary):

____________________________________________________________

* Entry Description (attach additional sheet if necessary):

____________________________________________________________

* Costumes created/compiled by:

____________________________________________________________

* Entry performed by:

___________________________________________________________

Legal Stuff:
By entering the Capricon 25 Mad Scientist Show-N-Tell, I give permission to Capricon and its designees, and the Show-N-Tell Director, to photograph and/or videotape my costume and performance and to use these photographs and/or videotape as the convention sees fit. I also attest that I am eligible to compete per the Capricon 25 Mad Scientist Show-N-Tell Rules and that all other information provided on this entry form is true and correct.

I also, hereby, acknowledge that I, as the primary contact for this entry, will be asked to sign a paper copy of this form at the Show-N-Tell Check-In at the convention. I also understand that if I do not sign, my entry will be disqualified.

* Signature (parent’s signature for minors)

____________________________________________Date____________

Capricon 25 Show & Tell Registration Form

*Mailed* in entries must be received by January 29, 2005 or Hand in your form at the convention by 7:00 pm Friday, February 11, 2005		Capricon 25 Attn: Show & Tell PO Box 60085 Chicago IL, 60660

Entry Number _________(for office use only) ( Indicates required field)* * Name _____________________________________________________ * Address ___________________________________________________ * City_________________________State__________Zip____________** Phone Number ______________________________________________** * Email Address _____________________________________________ * Entry Type (select one) [.. ] Adult/Individual [.. ] Adult/Group [.. ] Youth (12 and under)/Individual [.. ] Youth (12 and under)/Group Emcee Script (attach additional sheet if necessary): ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ * Entry Description (attach additional sheet if necessary): ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ * Costumes created/compiled by: ____________________________________________________________ * Entry performed by: ___________________________________________________________ Legal Stuff: By entering the Capricon 25 Mad Scientist Show-N-Tell, I give permission to Capricon and its designees, and the Show-N-Tell Director, to photograph and/or videotape my costume and performance and to use these photographs and/or videotape as the convention sees fit. I also attest that I am eligible to compete per the Capricon 25 Mad Scientist Show-N-Tell Rules and that all other information provided on this entry form is true and correct. I also, hereby, acknowledge that I, as the primary contact for this entry, will be asked to sign a paper copy of this form at the Show-N-Tell Check-In at the convention. I also understand that if I do not sign, my entry will be disqualified. * Signature (parent’s signature for minors) ____________________________________________Date____________
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