Conjuration
Science Fiction and Fantasy Convention
June 15, 16 & 17 2001

P.O. Box 874
Columbia, MO 65205-0874

Professional Registration Form

Phone ( _____ ) _____ - ____________

  Date _____ / _____ / _______
 
Name _________________________    Badge Name _____________________


Address ___________________________________________________________


City ____________________________

  
State ______		  
Zip ________


E-Mail Address  ______________________________________________________

Panel Topic(s)  ______________________________________________________

Special Requests ___________________________________________________
Names of Additional Registrants (if any) 
     (Cost for Additional Non-Professional Registrations is $10 each)

Name _________________________    Badge Name ____________________
 
Name _________________________    Badge Name ____________________
 
Name _________________________    Badge Name ____________________
 
Name _________________________    Badge Name ____________________
Submit Registrations to:
Conjuration
P.O. Box 874
Columbia, MO 65205-0874
Phone (573) 874-0801		 Hotel Reservations:
Columbia Best Western
3100 I-70 SE (I-70 and US63)
Columbia, MO 65203
(573) 474-6161