Registration World Fantasy Convention 2005

_________________________________________________ ____ Attending $150
First Name Last Name
_________________________________________________ ____ Supporting $35
Street Address
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City State Postal Code Country
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Phone Email address
_________________________________________________ ____ Attending $150
Additional Person Name (First, Last)
_________________________________________________ ____ Supporting $35
Street Address
_________________________________________________
City State Postal Code Country
_________________________________________________
Phone Email address
WORLD FANTASY AWARDS BANQUET tickets are $35 per person. The banquet will be held Sunday afternoon, doors opening at 12:30 and serving at 1 p.m. Please select from the options listed. Entrees include spinach salad with bacon dressing, wild rice pilaf, vegetable, coffee, tea, milk and dessert cake.
1) Madison Chicken: Gorgonzola and morel-stuffed chicken breast with cranberry demi-glace ________ (No. of servings chicken)
2) Pork Porterhouse: Lightly blackened 1" center cut chop with horseradish cream and Door County cherry sauce. ________ (No. of servings pork)
3) Chef's Choice Vegetarian (it's a surprise). ________ (No. of servings vegetarian)
________ Total ($) Banquet Tickets
________ Total enclosed (memberships and banquet tickets)
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Card type (Visa/MC) No. Exp, Date   Authorization Number
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Name on card Signature

Checks in U.S. funds from U.S. financial institutions should be made payable to WFC-Madison.
No checks or money orders written on foreign banks.
NO REFUNDS
(Memberships are transferable. Contact us for more information.)

______ I am interested in participating in programming

______ I am interested in child care for a fee, if available.

I am (circle those that apply)     author     artist     bookseller     editor

agent     publisher     other ______________

PLEASE MAIL REGISTRATION TO: after October 20, please pay at the door

WFC-Madison
P.O. Box 531
Cambridge, WI 53523
USA

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