Registration Form
RATES:
$35 Adult / $17.50 Child until July 31st
($40 Adult / $20 Child until October 31st)
Make checks payable to Loscon 30.
Send your check and the following information to:
Loscon 30
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 02/03 |  REGISTRATION |