BayCon℠ 2009 Membership Form

□	$65 until 10 May 2009 $75 at the door	- or -	□	$25 Youth (age 8-12 as of May 21, 2009)

Mail with your check or money order made out to:

BayCon 2009 • P.O. Box 62108 • Sunnyvale, CA 94088-2108

Please Type or Print Neatly	Date:
Name:
Fan Name: (for badge)
Business Name: (for badge)
Address:
City:	State:	ZIP/Postal Code:
Phone:	E-mail:

_____Privacy request (Do not print my name in convention publications or on the BayCon 2009 web site)