Noircon 2010 Registration Form

Print Form

November 4th, 5th, 6th and 7th Philadelphia, PA Registration Form

________________________________________________________________________________ Name ________________________________________________________________________________ Address ____________________________ City

_____________ State/Province

_____________ ___________________ ZIP/Postal Code Country

________________________________________ ______________________________________ Email Adress Telephone Number



Panelist

Writer

Fan



Friend/ Family

Publisher

Collector

Other

Rates: $180 (Award Banquet included) BEFORE December 31, 2009 $200 (Award Banquet included) AFTER January 1, 2010 $50 (Award Banquet for Spouse of Registrant) Total Amount Remitted; _________________________ Paid by

Check or

Credit Card (Visa, Master Card, Amex) No.:___________________________



Exp/Date:_______________________

Mail this form with your check made out to NOIRCON 2010/ Society Hill Playhouse to: NOIRCON c/0 Society Hill Playhouse 507 South 8th Street Philadelphia, PA. 19147

Call (215) 923-0211 for more information.

NoirCon Hotel: Doubletree Hotel, 237 South Broad Street Philadelphia, Pennsylvania 19107-5686 215-893-1600. $149/Night Book early. Rooms are limited at the convention rate.