ADAMCON 09 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________________________

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


 Delegate                  $265.00  _________
    Non-Delegate Spouse    $195.00  _________
    Non-Delegate Child     $ 55.00  _________
    Delegate Child         $115.00  _________

 Single room    
 +$30.00 per night                  _________

 Day Pass
     Friday                $ 19.00  _________
     Saturday              $ 19.00  _________
     Sunday                $ 23.00  _________

 T-Shirt                   $ 10.00  _________  (FREE if paid in full
     sizes M L XL XXL                           before 15 April 1997)
 Hat                       $  7.00  _________  (FREE if paid in full
                                                before 1 June 1997)

                          TOTAL     _________
                   DEPOSIT/PAID     _________
                    BALANCE DUE     _________


Make checks (payable in U.S. funds) to "ADAMCON 09"  and send with completed
registration form to:

                Bob & Judy Slopsema 
                2261 ShadeTree Lane S.E.
                Kentwood, MI 49546-7585
                USA
                Voice:   (616) 949-9461
                E-mail:  [email protected]

We will see you at ADAMCON 09 in sunny, pleasant Grand Rapids, Michigan!