CopperCon 24 Membership Form

Memberships:
$30 thru 4/30/04 $35 thru 8/27/04, $40 at the door
(Kids 7-12 half price with Adult membership)

Name:______________________________________

Badge Name:________________________________

Address:___________________________________

City:__________________________ State:______ Zip Code:____________

Phone:( )____________ Email:_____________________

Over 12?: ( )yes ( )no

I am interested in:___Displaying in Art Show __Participating in Masquerade

__Dealers Room __Running/Sponsoring a Game __Volunteering to help the convention

Print this form out using your Web Browser and send along with a check or money order to: CopperCon 24, P. O. Box 62613, Phoenix, AZ 85082-2613

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