Membership Form

CC25 Membership Form
*** We do not accept Credit Cards for payment through the mail***
*** Credit Card payment will not be available at the door***
*** We are set up to accept online payment* at this time.***
(* there is a $3 processing fee for electronic payment, & not after March 17, 2007)

To use this form -
print it from your browser and mail it to the Convention address below

After March 17 - Registration at the Door ONLY!!!

Costume-Con 25 Membership Form
March 30 through April 2, 2007
To register: fill out the form and return to the CC25 mailing address (below)

REQUIRED FIELDS*:
Name(s):_______________________________________________________________________

Address:________________________________________________________________________

City:___________________________________________ State:___________________________

Zip/Postal Code:_____________________________ Country: ____________________________

Email:_________________________________ Phone#:_________________________________

Age (circle one or note where applicable if multiple):  <12   12-18   18-21  >21

Circle 1 (one) option below; 
YES - I would like to receive mailings from future Costume-Cons*
 NO - I don't want to receive mailings about future Costume-Cons*

OPTIONAL:
Badge Name(s) [if desired]:___________________________________________

ICG Member:  Y  N   Which Chapter:____________________________________

Multiple Names at one address - One set of publications:  Y  N

I have attended __________ Costume-Con(s) [fill in the number of times/cons you have attended]

* All information collected on this form will be held confidential to Costume-Con 25 or 
future Costume-Cons only as authorized by the individual named herein.

Complete 4-Day Attending Rates:
Now and at the door: $95

One day rates:
$50 Saturday or Sunday

Supporting (non-attending) Rate:
$45 at all times - Includes all publications

(All rates are in US Dollars)

Mail all inquiries to the following address:

Costume-Con25
c/o Mai
7835 Milan
St. Louis, MO 63130

Or email: SLCG@email.com
www.cc25.net/index.html

Dealers Tables:________ x $65 (Membership not included; click here for more info)

Make Check or Money Order Payable to: St. Louis Costumers Guild [Do NOT send cash]

DO NOT fill out the remainder of this form; 
It will be filled out by the Convention Staff and returned to you as your receipt

Membership #: _____________

Member name(s): _________________________________________________________

Type of Membership: _________________   Date received: ____________________

Amount Received: ____________________	Type of Tender: ___________________

This site sponsored by the CC25 Committee, the SLCG, and Friends.
Costume-Con® is a registered service mark of Karen Dick,
used by permission.