If you plan to attend any of the HomiCon 2001 events, please print this form and fill it out, then mail it, with a cheque or money order for the correct amount to:

Katherine Wilhelm
122 W. Cloverdale Avenue
Shrewsbury, PA 17361

If you don't have a printer, you can send a hand-drawn facsimile. For details on these activities, please see the itinerary. All prices are in US funds.

Full Name:_____________________________________

Email Address:_________________________

Phone Number: (day)_________________(evening) _________________

Please check the activities you plan to attend:

Redball Cocktail Party ____ $30
Zippy's Walking Tour ____ $15
Seminar/Panel Discussion ____ $10

I have enclosed a cheque/money order in the amount of $________.

I will pay at the door ____

Your payment in full must be received no later than Thursday October 18, 2000.

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