Personal Details (*) indicates that the field is optional Name: _____________________________   Address: _____________________________   _____________________________   _____________________________   _____________________________   Town/City: _____________________________   Area/Zip Code *: _____________________________   Badge Name *: _____________________________ This is the name that will go on your badge, and will also be used in the membership listing on the P-CON website. If left blank we will presume you wish us to use your real name.   Type of Membership: Attending    Supporting Details of membership rates are available in the box on the right. A supporting membership freezes the cost at time of payment.   E-Mail Address: _____________________________   Telephone *: _____________________________

Membership Rates Applications received before: Applications before: Euro Sterling Eastercon (21 April 2003) €25.00 £16.00 22 September 2003 €30.00 £20.00 On the door €35.00 £22.50 Supporting Memberships   €10.00 Cheques should be made payable to: P-CON Application Forms and Payments can be sent to: P-CON C/O Yellow Brick Road 8 Bachelors Walk Dublin 1 Suggestions Anything you want to see at P-Con? Want to suggest panel topics, perhaps? Here's your chance! ____________________ _____________________ _____________________   Be a Gopher Want to help out at P-Con? Just tick here. Yes, I would love to be a gopher