First Name:

Last Name:

E-Mail Address:

Street Address Line 1:

Street Address Line 2:

City:

State/Province:

Country

ZIP/Postal Code:

Units
Ordered

Line Item Description

Price
Per Each

Total Cost

- 

Adult Weekend Registration(s) 

(

35.00

)

 - 

$0.00

- 

Child (12 and under) Weekend Registration(s) 

(

17.00

)

 - 

$0.00

- 

Child (5 and under) Weekend Registration(s) 

(

0.00

)

 - 

$0.00

- 

Artist workshop hosted by Ed Beard Jr. 

(

22.00

)

 - 

$0.00

- 

Geek Knitting workshop - Supplies for Doctor Who scarf 

(

20.00

)

 - 

$0.00

- 

Geek Knitting workshop - Supplies for Jayne Cobb hat 

(

26.00

)

 - 

$0.00

Prices valid BEFORE Saturday June 19th, 2010

$0.00

* Please include a full name, or badge name, for each Weekend Registration (one name per line).

Once you have filled in all of the information above, you can choose to place your order either by using the PayPal web payment system (if paying with a credit card) or by printing and mailing your registration via U.S. Mail (if paying by check or money order).
 

Note: Fields marked with an asterisk (*) are required fields.