Capricon 30

126 E. Wing Street #244, Arlington Heights, IL 60004

Registration Important, please note: Our privacy policy is simple - we will never sell, display, or show your personal information to any third party without your prior and explicit approval. By giving us your e-mail address you are consenting to receive occasional e-mail announcements from Capricon and Phandemonium. You may request your e-mail to be removed from our distribution list at any time. Pre-registration price is currently $ per person. Kids-in-tow (children under the age of 12 that are with a parent at all times) are free. Please fill out this form and mail it in with your payment before January 31, 2010! Please fill in the following information for the primary registrant and up to ten additional people. All people must live at the same address. If you need to register more than ten people, please break them up into groups of ten or fewer. The fields marked with an asterisk (*) are mandatory. Additional registrants after the primary need only fill in a name and badge name. WARNING: This form works best with Javascript. If you do not have Javascript turned on, you may not see some features.
First Name:		Last Name:	*
Address 1:	*
Address 2:
City:	*	State:	*
Zip Code:	*	Phone Number:
	Please do not contact me by mail.
	Please do not contact me by phone.
Badge Name:	*
E-mail Address:	*
	Please do not contact me by e-mail.

Secondary Registrations

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Kids in Tow

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