LOSCON 32 Registration Form
RATES (from now and at the door):
$45 Adult
$22.50 Child
Make checks payable to Loscon 32.
Send your check and the following information to:
Loscon 32
C/O Los Angeles Science Fantasy Society
11513 Burbank Blvd.
North Hollywood, CA 91601
Name:____________________________________________________________
Badge Name (Optional):____________________________________________
Address:__________________________________________________________
City:______________________________State:________Zip:______________
Country (If not United States):______________________________________
Phone:______________________Email (Optional):______________________
OK to list name online? Y ( ) N ( )
Quantity: ______
Amount: ______
Total: ______
Webform 08/05 |  |