Keycon 16

Membership Information
Adult Memberships
Childrens Memberships

Adult Membership Information
May 18th till December 31st,1998
$30.00
January 1st till April 30th, 1999
$40.00
At the Door Price
$50.00
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Childrens Membership Information
May 18th till April 30th,1999
$25.00

At the Door Price
$30.00
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To get your membership print out the following and mail it along with your payment to:

P.O. BOX 3178
WINNIPEG, MANITOBA
CANADA
R3C 4E6


Name:__________________________________________________________________

Address:________________________________________________________________

City:_________________________ Province/State:______________________________

Postal/Zip Code:__________________ Country:_________________________________

E-mail Address:__________________________________________________________

Phone Number:(_________)_______________________________________________

Date of Birth:____/_____/_____ Male:_____ Female:______

Badge Name:___________________________________________________________

Signature:______________________________________________________________

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