Capricon 27

126 E. Wing Street #244, Arlington Heights, IL 60004

Registration fees are $40 per membership. Please fill out this form and mail it in with your payment before December 31, 2006! Fields marked with an asterisk are required. Please make checks payable to Capricon 27. Note: Information can be typed prior to printing.
Capricon does not sell personal information to anyone. By giving us your e-mail address you are consenting to receive occasional e-mail announcements from Capricon and Phandemonium. You may request your e-mail to be removed from our distribution list at any time.
First Name:   Last Name: *
Address 1: *
Address 2:
City: * State: *
Zip Code: * Phone Number:
  Please do not contact me by mail.
  Please do not contact me by phone.
Badge Name: *
E-mail Address:
  Please do not contact me by e-mail.
 

Secondary Registrations

 
Select Number of Other Registrations

 

Kids in Tow

 
Select Number of Kids in Tow