Name:________________________________________________________________________

Address:_____________________________________________________________________

__________________________________________________Phone:(___)________________

Number of Adult Memberships: ______  ($25 until Aug. 1st, 1998, $35 thereafter)

Number of Child Memberships: ______  ($15 until Aug. 1st, 1998, $20 thereafter)

Children ages 6-13 may attend at the lower rates. Children 5 and below may 
attend free, provided they remain with a responsible adult at all times.

Total Amount Enclosed:  $________

     (Make Checks Payable to ConFluence -- Do NOT send cash in the mail!)

The name I would like printed on my membership badge is:_____________________

Additional Attendee Names:              |   Their Badge should read:
                                        |
________________________________________|____________________________________
                                        |
________________________________________|____________________________________
                                        |
________________________________________|____________________________________
                                        |
________________________________________|____________________________________

I've included a SASE so that you can send me more information about:
 _
|_|   Art Show
 _
|_|   Being a Go-fer
 _
|_|   Dealers' Tables
 _
|_|   Program Book Ads
 _
|_|   Short Story Contest

Send this form, with check or money order, to:

ConFluence '98 * P.O. Box 3681, Pittsburgh, PA 15230-3681 * (412)344-0236

http://www.andrew.cmu.edu/user/roboman/confluence.html