PRE-REGISTRATION and MEMBERSHIP FORM
Print out form, fill it out and send it with your check or money order to: Cinecon 3727 W. Magnolia Boulevard, # 760 Burbank, CA 91505
Pre-Registration Discount Offer Good Through Aug. 15

Name:	_______________________________________________________________
Address:	_______________________________________________________________
	_______________________________________________________________
City:	________________________________			State: ________		Zip: ___________
Phone:	__________________________		e-mail:	____________________________
	(optional)			(optional)
Pre-Registration Discount $150.00 each (registration, membership & celebrity banquet)			# _________		$ ____________
Or, order separately:
Full Registration $80.00 per person			# _________		$ ____________
Membership (required*) $20.00 each			# _________		$ ____________
Celebrity Banquet $85.00 each			# _________		$ ____________
TOTAL:			# _________		$ ____________
Make Checks payable to: Cinecon
*Please note: Cinecon Membership is Required for Attendance