InConJunction, Circle of Janus
P.O. Box 68514
Indianapolis, IN 46268-0514

Note: We do not provide babysitting services for our fans with young children.
You are responsible for the supervision of any children that you bring.


Hang on to your badge at the convention!
Lost badges can only be replaced with the purchase of a new registration.


Registration(s)

Full Name: Address:
Badge Name: Apt #:
E-Mail: City:
Age (under 16): State: Zip:

Full Name: *Address:
Badge Name: Apt #:
E-Mail: City:
Age (under 16): State: Zip:

Full Name: *Address:
Badge Name: Apt #:
E-Mail: City:
Age (under 16): State: Zip:

Full Name: *Address:
Badge Name: Apt #:
E-Mail: City:
Age (under 16): State: Zip:

* If all registrations listed reside at a single residence, write "same" in the remainging address entries.
Registration Until
04/15/99
Until
06/01/99
After
06/01/99
Number of adults at: $20.00 $25.00 $30.00 Subtotal: $
Number of children (age 6-12) at: $10.00 $12.50 $15.00 Subtotal: $
Number of children (under 6) at: --- No Charge --- Subtotal: $ 0.00

Total: $