Chicon 2000: Registration Form 19990623 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chicon 2000, PO Box 642057, Chicago IL 60664 Please Print Clearly: Name: _______________________________________________________________________ Address: ____________________________________________________________________ City:_________________ State/Country:____________ ZIP/Postal Code:___________ Phone: ________________ E-mail (optional) ___________________________________ As of 01-Oct-1999 Attending membership ...................................... .... $150 Supporting membership ..................................... .... $ 40 I voted - convert from supporting to attending ............ .... $110 Child's Membership ..... Date of Birth ____________________ .... $ 50 (does not receive publications or have voting rights) Childcare Membership ... Date of Birth ____________________ .... $150 Amount due $___________ Send a check or money order payable to Chicon 2000 to the above address. Or fill in credit card information below, and mail it or e-mail to reg@chicon.org. [_] MC [_] Visa Number: ____________________________ Exp: ___ /____ Name as it appears on the card: ________________________________________ Signature: _____________________________________________________________ Please send additional information about: [_]volunteering [_]program - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - A child-in-tow (no membership, under 9 years of age) must be with parents at all times. Childcare/baby-sitting rates are the same as Attending. Children's (under 13) attending membership rates are $50 (do not receive publications or have voting rights). [Webmaster's note: If you were born on or after 01-Sep-1987, you qualify for the $50 rate.]

If you voted in the site selection balloting in 1997, you have a supporting membership. You can convert this to an attending membership by paying the difference between the current attending rate and the $40 you already spent.