Registration Form Name _________________________________________________________________ Address _______________________________________________________________ City ________________________________ State _______________ Zip____________ Phone __________________________________ e-mail _________________________ Your names as you would like them to appear on your conference badge(s): _________________________________________________________________________ Names of other people registering with you (Spouse, child) 1. _________________________________ 2. _________________________________ 3. _________________________________ 4. _________________________________ _____ Registration $149_____
Spouse
registration $100. _____ Adult Ticket Package
$75. (Tickets to 2 evening shows, and the
all-star show. No lectures included. Must be
accompanied by at least one
registration). TOTAL REGISTRATION: ________________________________________________ _____ Check Enclosed (Payable to Dazzling Magic) _____ Please bill my credit card Card Number _________________________________ expires __________________ Signature
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