InConJunction, Circle of Janus
P.O. Box 68514
Indianapolis, IN 46268-0514
Note: We do
not
provide babysitting services for our fans with young children.
You are responsible for the supervision of any children that you bring.
Hang on to your badge at the convention!
Lost badges can only be replaced with the purchase of a new registration.
Registration(s)
Full Name:
Address:
Badge Name:
Apt #:
E-Mail:
City:
Age (under 16):
State:
Zip:
Full Name:
Address:
Badge Name:
Apt #:
E-Mail:
City:
Age (under 16):
State:
Zip:
Full Name:
Address:
Badge Name:
Apt #:
E-Mail:
City:
Age (under 16):
State:
Zip:
Full Name:
Address:
Badge Name:
Apt #:
E-Mail:
City:
Age (under 16):
State:
Zip:
*Note: If all registrations reside at a single residence, only complete the first address entry.
Registration
Until
03/01/99
Until
05/01/99
After
05/01/99
Number of adults at:
$25.00
$30.00
$35.00
Subtotal: $
Number of children (age 6-12) at:
$12.50
$15.00
$17.50
Subtotal: $
Number of children (under 6) at:
---
No Charge ---
Subtotal: $
0.00
Total: $