Westercon 48 Membership Form



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

        Westercon 48
        PO Box 2584
        Portland, Oregon 97208-2584

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 Westercon 48?
        [] At the Convention   and/or [] On the Planning Committee

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

Please send information on: [] Art Show  [] Ad Rates [] Child Care 
                            [] Handicapped Access    [] Masquerade

Other information requested/comments:

__________________________________________________________________


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