|
Name:_____________________________
Badge Name (if different):_______________
Address: __________________________
City/ST/ZIP: ________________________
Phone: ____________________________
E-Mail: ___________________________
O Please check here if you'd like the
registration confirmation and the update sent by email. If you choose this
option, you do not need to send a SASE. Please print legibly.
For credit card payments only:
Account #: _________________________
Exp. Date: _______ Circle: MC / VISA
Signature: _____________________________
|
|
| Adult Weekend Membership ($80) |
$_______ |
Teen Membership ($50)
(ages 13-17) |
$_______ |
Youth Membership ($20)
(for children ages 5-12) |
$_______ |
| Adult Friday Only Membership ($30) |
$_______ |
| Adult Saturday Only Membership ($60) |
$_______ |
| Adult Sunday Only Membership ($40) |
$_______ |
| Active Military receives a $10 Discount (Must present ID at pickup.) |
Supporting Membership ($10)
(non-attending, incl. program book and badge) |
$_______ |
| Badge numbers for one day memberships will be numbered after weekend badges.
|
| Total this section |
$_______ |
|
Photo Ops
Photo Ops with our celebrity guests will be offered
as they are confirmed.
|
Official Shore Leave 34
T-Shirts (offered by pre-order, to be picked up at the convention)
Sizes S-XL: $20 Sizes 2XL-5XL: $22
(4XL and 5XL available by pre-order only)
|
|
| #Shirts |
Size |
|
| _______ |
______ |
$_______ |
| _______ |
______ |
$_______ |
| _______ |
______ |
$_______ |
|
Official Shore Leave 34 Bunny ($10)
(Includes this year's shirt, pre-orders to be picked up at the convention.) |
______ |
$_______ |
Official Shore Leave 34 Bunny Shirt only ($5)
(Shirt only, pre-orders to be picked up at the convention.) |
______ |
$_______ |
|
| Total this section |
$_______ |
|
|
Send More Information About:
Masquerade: __ Art Show: __
Blood Drive: __ Filking: __ Gaming: __
Child/Youth Programming: __
I Can Help With:
Art Show: __ Registration: __
Security: __ Blood Drive: __
Thursday PM/Mon AM Manual Labor: __
Anything you need: __
Fan Clubs You Belong To:
___________________________________
Fan Panel Topic Suggestions:
___________________________________
___________________________________
|
Workshops:
| Workshop details will be published as they become available. |
US funds only! |
|
| Total Enclosed: |
$_______ |
Mail this form to: Shore Leave, PO Box 6809, Towson, MD 21285-6809.
|
|
Refund Policy: Con memberships are transferable with the approval of the convention
registration committee. Workshops are not refundable unless said workshop is canceled. No registration
refunds given after July 15, 2012.
