MILLENNICON-4 ® PRE-REGISTRATION

Instructions

Below is a pre-registration form for MILLENNICON-4 ® .
You MUST mail the completed form in with payment in order to reserve your place and receive admission.
Please PRINT this page, fill in the information and mail to the address below.
Thank You

Mail form and payment to:
MILLENNICON-4® Registration
143 Schloss Lane
Dayton, OH 45418

RATES: $25 Until January 31, 1997
$30 After January 31, 1997 and at the door.
Children 5 an under... Free
Children 6-11...$5
Children 12 and over... Full Rate 


NAME: ______________________________________________________________________


ADDRESS: ___________________________________________________________________


City: _____________________


State ____  Zip _____-____ 


E-mail Address ____________________@_______________________________


Banquet Tickets Adults.... $20.00  Children Age 10 and Under ... $10

Adults ____  Children ____       Total Tickets ____  Total Amount $________


Additional memberships


Name ___________________________________________________________    Age ______


Name ___________________________________________________________    Age ______



Name ___________________________________________________________    Age ______



Name ___________________________________________________________    Age ______



Requests for additiona information



__Art Show
__Benefit Auction
__Dealer Room 
__Gofers 
__Masquerade 
__Other 

=============================================================================
                       CONVENTION USE ONLY
=============================================================================

Date recv |Total number |Banquet Tickets |Total Amount |Check |Money |Processed
          | Memberships |                |             |Number|Order | BY
          |             |                |             |      |      |
          |             |                |             |      |      |
          |             |                |             |      |      |
mcon-prereg2
Author:Phillip Conrad [phil@homeworld.com]
Curators: Phillip Conrad
Last Revised: 27 Aug 1996 (P. Conrad)

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