The Millennium Philcon(R)

The 59th World Science Fiction Convention(R)

Philadelphia, PA, USA
August 30 to September 3, 2001

Preregistration Information - 
* Please Print Clearly *

Please list the names of members living at the 
same address. Use a separate form for each 
different address.

We will send progress reports to the first 
listed member. If other members listed on the 
form wish to receive publications please put an 
X on the line next to that member's name. 
Ballots will automatically be sent to every 
member.


           Send
       Publications?
Member 1   ____      Name ______________________  Badge Name ______________________

Member 2   ____      Name ______________________  Badge Name ______________________

Member 3   ____      Name ______________________  Badge Name ______________________

Member 4   ____      Name ______________________  Badge Name ______________________

Member 5   ____      Name ______________________  Badge Name ______________________

                  Address  _____________________
                  
________________________________________________

City, State, Postcode, Country  ________________

________________________________________________

                Telephone  _____________________
                
                    Email  _____________________

I'd like info about:
____      Volunteering
____      Dealer's Room
____      Art Show
____      Masquerade
____      Handicap Access


*THE RATES LISTED BELOW ARE  
EFFECTIVE JULY 19, 2001 - AUGUST 15, 2001
For rates in other currencies, please email us or write to our address below.

     Attending:                       $180. US (Dollars) - Number ____ - Total ____

	 
     Supporting:                       $40. US (Dollars) - Number ____ - Total ____
     (Gets publications and voting rights only)

     Convert:                         $140. US (Dollars) - Number ____ - Total ____
     (from Supporting to Attending)

     Child:                            $50. US (Dollars) - Number ____ - Total ____
     (Born after 9/1/89 - no child care, no voting rights):

               Total                      Total cost:      Number ____ - Total ____

Payment by (circle one): Cash, Check, Visa, MC, Amex

Please make checks payable to: The Millennium Philcon

Credit Card Information:
Credit Card type (circle one): Visa / MC / Amex
CC#_____________________
Exp. Date: ______________
I authorize the Millennium Philcon to charge 
my credit card - signature_______________________________



The Millennium Philcon
P.O. Box 310
Huntingdon Valley, PA 19006-0310
Email: info@milphil.org
http://www.milphil.org


Copyright (c) 2000, 2001 The Phanadelphia Corporation, 
all rights reserved.

Philcon(R) is a registered service mark of the 
Philadelphia S.F. Society, used by  permission.

Worldcon(R) is a registered service mark of the 
World Science Fiction Society, an unincorporated 
literary society.