OryCon 19 Membership Form

• Memberships in OryCon 19 are $30.00 until October 15th, $45.00 thereafter and at the door. (Please note that the dates for rate changes are different from previous years.)
• Children who will be 6-12 at the time of the convention are half price. Children 5 and under at the time of the convention are free. Children must be accompanied by an adult with a membership.

Please print out this form, fill it out, and mail it with your payment
to:

        OryCon 19
        PO Box 5703
        Portland, Oregon 97228

List any additional names and addresses on the back or on a separate
sheet.

Name _____________________________________________________________

Address __________________________________________________________

City/State _______________________________________________________

ZIP/Postal Code __________________  Phone ________________________

Alternate Badge Name _____________________________________________

E-Mail Address ___________________________________________________

Please tell us where you found out about this Web page:

__________________________________________________________________


Would you like to work on OryCon 19?
        [] At the Convention   and/or [] On the Planning Committee

In the: [] Art Show    [] Hospitality  [] Registration   
	[] Operations  [] Gaming       [] Other: _________________

Please send information on: [] Art Show  [] Dealers  [] Child Care 
                            [] Gaming    [] Other: _______________

Other information requested/comments:

__________________________________________________________________