Minicon Fortean Registration Form
Pre-register for Minicon Fortean 2005. Attending memberships are $35 to October 31, 2004, $40 to March 7, 2005. It will be $50 at the door. Child memberships are $15, Supporting memberships are $15.

Please Print

Name:_______________________________________Badge Name______________________________

Street Address:_________________________________________________________________________

City:_______________________________________State:_______________Zip:___________________

E-Mail:______________________________________________

Optional Phone:_____________________ Optional Cell Phone:______________________

Perferred Method of Contact:_______________ Perferred Time:____________________

Add to Mailing List - Volunteers:______________ Art Show:___________________ Dealers:_________________ Programming:________________

Membership type - Attending:___ Supporting:___ Child:___

Name:_______________________________________Badge Name______________________________

Street Address:_________________________________________________________________________

City:_______________________________________State:_______________Zip:___________________

E-Mail:______________________________________________

Optional Phone:_____________________ Optional Cell Phone:______________________

Perferred Method of Contact:_______________ Perferred Time:____________________

Add to Mailing List - Volunteers:______________ Art Show:___________________ Dealers:_________________ Programming:________________

Membership type - Attending:___ Supporting:___ Child:___

Name:_______________________________________Badge Name______________________________

Street Address:_________________________________________________________________________

City:_______________________________________State:_______________Zip:___________________

E-Mail:______________________________________________

Optional Phone:_____________________ Optional Cell Phone:______________________

Perferred Method of Contact:_______________ Perferred Time:____________________

Add to Mailing List - Volunteers:______________ Art Show:___________________ Dealers:_________________ Programming:________________

Membership type - Attending:___ Supporting:___ Child:___

Total enclosed

Mail this form to:
Minicon Fortean, P.O. Box 8297, Lake Street Station, Minneapolis, MN 55408