Death Equinox Registration Form

This is not a submit form. It should be snail mailed in, with your membership fee, to Death Equinox '01 PO Box 581 Denver CO 80201. (Checks and money orders must be payable to Jasmine Sailing)

Or you can pay for your membership by credit card, using paypal or paydirect, in which case the registration form should be emailed. The address to use for paypal and paydirect payment is jsailing@netonecom.net. My paypal account has a monthly receiving limit of $100 (credit card payments only, the limit doesn't apply to funds sent from an existing balance or your bank account), which rolls over on the 23rd of each month, of $100. Click one of the icons to sign up for paypal or paydirect.

Name_________________________________________________________
Mailing Address______________________________________________
Email Address________________________________________________

Enclosed is:
__ $25 for an attending membership (prior to 07/31/00)
__ $30 for an attending membership (prior to 11/30/00)
__ $35 for an attending membership (prior to 03/31/01)
__ $45 for an attending membership (prior to 08/31/01)
__ $50 for an attending membership (post 08/31/01)
__ $10 for a supporting membership (which can be upgraded to attending)
__ for __ dealers' tables
__ for __ art panels
___ is the total enclosed for above selections
(Please make checks and money orders payable to Jasmine Sailing)

Please check appropriate sections:

I am an:

__artist	    __fiction writer	  __journalist
__editor	    __publisher		  __musician/label rep
__film-maker	    __comics creator  	  __promoter
__mad scientist	    __techno-weenie	  __paranormal researcher
__astronomer	    __spiritual guru	  __hardcore fetishist
__drug expert	    __alien abductee	  __psychology buff
__euthanizer	    __delirious fan	  __other

I would like to enter the following contests: __critter ball
__metric crunch __gadgeteer's ball

__ I would like to be involved in programming

Please give a brief summary of your industry involvement:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Back to the Death Equinox Essentials.