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A-KON 22 MEMBERSHIP ORDER FORM: Make Checks or Money Orders to "Phoenix Entertainment/A-Kon 22"

(How Many)

1 regular membership(s) for A-Kon 22 ($30 for the whole show, concerts included, until DEC 1, then $35)

____ child membership(s)(ages 6-12) for A-Kon ($15) (5 & under is FREE)

_____T-shirt(s) ($20 each) __S __M __L __XL __2X __3X __4X (if getting multiple shirts, tell us WHO gets what size, please)If getting more than multiple memberships, but only 1 or 2 shirts, tell us WHO gets what shirt please)

_____Sunday Meet NGreet Reception with the Stars ($29 ea.) (includes buffet, visits from multiple guests throughout the event, other entertainment, showing of winning AMVs and more!)

YOUR NAME:Erica Walsh (if ordering more than one membership, give us full names of ALL attendees. Use extra paper if necessary (or print separate forms) and please PRINT or TYPE CLEARLY). Multiple membership requests WITHOUT names for everyone cannot be processed. (We would actually prefer if each member had their own sheet filled out, OR the info all typed into one nice easily readable sheet)

NICKNAME FOR BADGE (max. 18 letters & spaces): Errricuh Use Standard Letters or Numbers Only (no symbols or characters)

NO profanity, suggestive, hateful or rude badge names please. A-Kon reserves the right to require change of badge name at our sole discretion

ADDRESS:1117 Sierra Dr. CITY:DentonSTATE: TexasZIP: 76209 EMAIL:mrsgreenleaf92@hotmail.comAGE (by 6-09-11): 19