Membership Form

Please print out this page,
fill it out,
and mail it with check or money order
made out to "LASTSFA" with "Albacon 2001" on the memo line
(no cash or credit cards please)
to :

Albacon 2001
P.O. Box 2085
Albany, NY 12220-0085
USA

First Name : __________________________________________________
Last Name : ___________________________________________________
Badge Name (if different) : ___________________________________
Email address : _______________________________________________

Would you like to receive information about Albacon via Email ?
Please circle one : ...Yes...-...No...

Mailing Address

Street : ____________________________________________________
Apt : _______________________________________________________
City : ______________________________________________________
State / Provence : __________________________________________
Zip / Mail Code : ___________________________________________
Country : ___________________________________________________

Additional Memberships at the same address

First Name : _________________________________________________
Last Name (if different) : ___________________________________
Badge Name (if different) : __________________________________
Email address : ______________________________________________

Would you like to receive information about Albacon via Email ?
Please circle one : ...Yes...-...No...

First Name : _________________________________________________
Last Name (if different) : ___________________________________
Badge Name (if different) : __________________________________
Email address : ______________________________________________

Would you like to receive information about Albacon via Email ?
Please circle one : ...Yes...-...No...

First Name : _________________________________________________
Last Name (if different) : ___________________________________
Badge Name (if different) : __________________________________
Email address : ______________________________________________

Would you like to receive information about Albacon via Email ?
Please circle one : ...Yes...-...No...

If you have even more Memberships at this address,
just attach another sheet with the names.

______ Full Memberships at $33 (before 9/10/2001)   = $ _______
	               
______ Gaming Memberships at $10 (before 9/10/2001) = $ _______
	               
                                              Total = $ _______
	
    

Albacon is an activity of LASTSFA, a 501-C-3 Non-Profit organization.

This Site is maintained by the Albacon Committee Publications Staff.
This page was last updated on : Tuesday October 2, 2001 at 10:24 PM