Conucopia: Registration Form                                       19990622

                                  CONUCOPIA
                             August 26-29, 1999
                          Anaheim Marriott, Anaheim
                                  California



Name ______________________________________ Badge Name _______________________


Address ______________________________________________________________________

                                                          Zip/Post
City ________________________________ State/Prov__________  Code _____________


Country______________________________ E-mail _________________________________


__ Attending Membership ....................................     $100

__ Kids 5-12 ...............................................      $50
   born on or after 27-Aug-1986, and on or before 26-Aug-1994.
   Kids-in-tow up to 4 years old are free.

__ Conversion: Voted at LoneStarCon 2 ......................      $80

__ Supporting Membership (Must pay conversion fee to attend)      $20



Conucopia
NASFIC '99
c/o S.C.I.F.I. Inc.
PO Box 8442
Van Nuys CA 91409

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