CONTERPOINT 2010 PREREGISTRATION FORM



Name: ___________________________________________

Address: ________________________________________

         ________________________________________

Phone: __________________________________________

E-Mail: _________________________________________

(Name & Address needed for contact; other items optional)

____ I am interested in scheduling a performance

____ I am interested in volunteering to help with

         ________________________________________

$________  for _______ preregistered memberships ($50 each)

                (memberships will be $60 at the door)

$_______  for _______ premiere memberships ($75 each)

                (includes listing in program book,

                special CD, and other goodies)

$_______  for _______ supporting memberships ($15 each)

                (includes all convention publications)

$_______  for _______ child (age 7-12) memberships ($10 each)

                (Children 6 and under admitted free.

                 Children must be supervised, and do not

                 receive separate copies of publications)

$________  TOTAL

Please make checks payable to Conglomeration
Mail to:
Conterpoint 2007
c/o Stephen Brinich
5911 Veranda Drive
Springfield VA 22152

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