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: Membership in the Society for Cinephiles/Cinecon
Required for attendance