KazCon 2009

Member Registration

(Please fill out a separate form per each person attending.)

Name: _______________________________________________________________________

Address: _____________________________________________________________________

Phone #: __________________________ Email: ____________________________________

Name/Moniker you wish to use for Kazcon: ________________________________________

Total $ Enclosed: _____________

Type of Membership:
__Early Bird Registration (before June 10, 2009) - $115; __Supporting Membership - $15
__Late Registration (after June 10, 2009) - $140; __Hell Hound - $90 (committee approval)

Payment:
__ In Full __Down Payment - $60 (balance to be paid by July 23, 2009)

Method of Payment:
__Check __Money Order __ Paypal (must have committee approval)

Who would you prefer on your official con badge?
__Sam __Dean __ Both

If arrangements are made, are you interested in participating on the ghost tour for an extra fee? (not to be paid now)
__Yes __ No

What is your preference for lunch on Friday?
__ Open-faced Hot Beef Sandwich
__ Cobb Salad w/Grilled Chicken
__Vegetarian Plate

Would you be willing to donate $5 for a pizza party on Friday night in the committee suite? (not to be paid now)
__Yes__No


Disclaimer: KazCon, the Holiday Inn Holidome, and all associates of KazCon are not responsible for any injuries or lost/damaged items during the convention.


Signature: __________________________________________________

Date:___________________

Make checks or money orders payable to: Tonya Howell
Mail this form and payment to:
Kazcon
c/o Tonya Howell
5700 N Wyoming Ave
Kansas City, MO 64118