June 6 – 8 , 2014 at The Hilton Anatole Dallas

A-Kon 25 Mail in Form

Just print this form. Fill this form out, and then mail it to:Phoenix Entertainment 3000 Custer Rd., Ste 270-337 Plano, TX 75075
SEND ME ___________ A-Kon ® 25 Memberships at $55.00 each. (make checks payable to “Phoenix Entertainment/A-Kon 25″)
And I want __________ T-shirts at $20 ea. Size: _______ (S, M, L, XL, 2XL, 3XL are available and will be supplied with your pre-reg pack)
Shirt Color ___ White ____ Black ____Other(if ordering multiple shirts for people, tell us who gets what size!)
FULL NAME ___________________________________________________________________________________
If you are buying more than one membership, please provide us full names, as well as full contact information, on ALL persons attending. Use extra paper if necessary (or use additional forms) and please PRINT or TYPE CLEARLY. Multiple membership orders WITHOUT names and contact information for EVERYONE CANNOT be processed.Not providing full contact information WILL result in the individual paying the FULL PRICE for registration at the door, since the registration can not be fully processed without the information.
REAL NAME:
___________________________________________________________________________________
NICKNAME FOR BADGE (max. 18 letters No profanity or naughty words)
___________________________________________________________________________________
US Standard Letters or Numbers Only (no symbols or characters)
ADDRESS: ________________________________________________________________________ APT:
CITY:_____________________________________STATE ______ZIP __________
EMAIL:________________________________________________AGE _________
MAKE CHECKS PAYABLE TO: Phoenix Entertainment/A-Kon 25
SEND TO: Phoenix Entertainment 3000 Custer Rd., Ste 270-337 Plano, TX 75075
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