CONvergence 2012 Registration Form

Complete this form and hit the "Create Registration Sheet" button. A printable version of this form will then appear, already filled out. Please print this out and send it with your payment (check or money order, US funds only) to:

Convergence Events Inc.
PO Box 11996
St Paul MN 55111-0996

This form CANNOT be submitted on line. This is only an on-line tool to help you create and complete a pre-registration form.

2012 Registration:

Adult Membership
Until December 31, 2011....$50
Until May 15, 2012.........$60
At The Door................$100

Ages 13-17
Until December 31, 2011....$40
Until May 15, 2012.........$40
At The Door................$60

Ages 6-12
Until December 31, 2011....$20
Until May 15, 2012.........$20
At The Door................$30

Kids 5 and Under.......Free

Full Name:

Street Address:

City:

State/Province:

Zip/Postal Code:

Country:

Phone:

Email:

Badge Name:

Badge Type:

	Adult (18 years old or older)
	Ages 13-17
	Ages 6-12


Volunteer Information:
I would be interested in volunteering:
	During the year
	Convention set-up
	During the convention
	Convention tear-down

I would be interested in volunteering for the following area:
	Connie's Space Lounge	Registration
	Publications	Art Show Staff
	Operations	Programming Staff
	ConSuite	Programming Panelist
	COF2E2	Concessions
	Badgers/Gophers	Gaming
	Volunteers	Theater Nippon
	Connie's Quantum Sandbox
Put me wherever I am needed! -

I would be interested in information on:
	Art Show / Auction
	Advertising
	Room Parties
	Working with GPS
	American Sign Language (ASL) translation service at the convention.

REMEMBER:

This form CANNOT be submitted on line. It must be printed and mailed with payment (as appropriate) to:

Convergence Events Inc.
PO Box 11996
St Paul MN 55111-0996

You can also download a pdf version of the 2012 Registration Form.

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CONvergence 2012 Registration Form

2012 Registration:

Volunteer Information:

REMEMBER: