ADAMCON 10 REGISTRATION FORM

NAME_______________________________ SPOUSE___________________________________

ADDRESS___________________________________________ PHONE:____________________

CITY____________________STATE/PROV______________ZIP/POSTAL CODE______________

CHILDREN:  1st ____________________AGE ____ 2nd ______________________AGE ___

If travelling alone and wish to share a room, check here_____
  Enter name of person you wish to have as a roommate, if known________________________

Do you wish to be in a non-smoking room? YES____ NO____

 Delegate                  $270.00  _________
    Non-Delegate Spouse    $200.00  _________
    Non-Delegate Child     $ 60.00  _________
    Delegate Child         $120.00  _________

 Single room    
 +$30.00 per night                  _________

 Day Pass (lunch only; see fee schedule for other configurations)
     Friday                $ 24.00  _________
     Saturday              $ 24.00  _________
     Sunday                $ 30.00  _________

 T-Shirt                   $ 10.00  _________
     sizes M L XL XXL
 Hat                       $  8.00  _________ 

                          TOTAL     _________
                   DEPOSIT/PAID     _________
                    BALANCE DUE     _________

Make checks (payable in U.S. funds) to "ADAMCON 10"  and send with completed
registration form to:

                ADAMCON 10
                2261 ShadeTree Lane S.E.
                Kentwood, MI 49546-7585
                USA
                E-mail:  72117.3003@compuserve.com

We will see you at ADAMCON 10 in Orlando, Florida come October 8th!