OryCon 21 Masquerade Registration

For Administrative Use: Presentation #  __________________

(PLEASE PRINT CLEARLY)

Name: __________________________________  Badge Number: ______________

Address: ____________________________________________________________

City: _________________  State: _______________  Zip: ________________

Phone Number: ________________ Email Address: ___________________________

Costume Name _______________________________________________________

Description ___________________________________________________________

Designed by (if different than entrant)________________________________

Made by (if different than entrant)___________________________________

Number of people on stage in presentation ____________________________

Names(s) of Additional Persons:

___________________________________    __________________________________

___________________________________    __________________________________

___________________________________    __________________________________

___________________________________    __________________________________

Please fill out and attach Tech and MC information!

Division:
Novice ___ Journeyman ___ Master___  Non Competing ___
Young Fan (self made) ___ Young Fan (Adult made) ___

General Categories (check all that apply): SF __  Fantasy __  Historical __ 
Original ___ Recreation  ___   (Documentation should be handed in with registration) 

General Mood:  Horror ___  Humorous ___  Beautiful ___ Dramatic ___  
Walk On ___ Other ___

Costume Color (check one) :  Black ___ Brown ___  Red ___ Orange ___ 
Yellow ___  Green ___  Blue ___  Violet ___ White ___ Gold ___ Silver ___
Flesh ___  Other: ______________

(Continued on back)


Presentation # ________


Liability Release
(ALL particpants MUST read AND sign before going on stage. A parent or guardian
must sign for a minor.)

I/We have read and understood the rules for this Masquerade as set forth in the instructions
and agree to abide by them. Further, I/We agree to permit photography and videotaping,
and to allow the sale/dissemination of these photos and tapes by OryCon.  Further, I/We do
agree to hold the convention, its organizers and the facility both severally and individually
blameless for any accident and/or injury suffered by me/us during the course of this Masquerade
and its rehearsals except in cases of gross negligence on the part of those cited above.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


(please include your badge number after your name)

Return to the OryCon 21 Home Page