Name:______________________________________
Badge Name:________________________________
Address:___________________________________
City:__________________________ State:______ Zip Code:____________
Phone:( )____________ Email:_____________________
Over 18?: ( )yes ( )no
I am interested in:___Displaying in Art Show __Participating in Masquerade
__Dealers Room __Running/Sponsoring a Game __Volunteering to help the
convention
Why not save yourself $5-$10 at the door? Print this form out using
your Web Browser and send along with a check or money order to: CopperCon
22, P. O. Box 62613, Phoenix, AZ 85082-2613
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