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Regstrationform13 (Prairie State College)

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2013 Maneki Neko Con
Friday and Saturday, Sept. 27 and 28
Registration Form
prairiestate.edu/animeclub
For deposit into Anime
Acct.#17-008126-49000-0000
Please use one form per address. Please print legibly.
1. Legal name ____________________________________________________
Street Address _________________________________________________
City _________________________ State _____ Zip _____________
Badge name ___________________________________________________
Email _______________________________________________________
Phone with area code ____________________________________________
***GoH Luncheon ****Friday Pass
2. Legal name ____________________________________________________
Badge name ___________________________________________________
E-mail _______________________________________________________
***GoH Luncheon ****Friday Pass
3. Legal name ____________________________________________________
Badge name ___________________________________________________
E-mail _______________________________________________________
***GoH Luncheon ****Friday Pass
4. Legal name ____________________________________________________
Badge name ___________________________________________________
E-mail _______________________________________________________
***GoH Luncheon ****Friday Pass
202 S. Halsted St. | Chicago Heights, IL 60411 | (708) 709-3500 | email ManekiNekoCon@prairiestate.edu
*Age at time of convention. For student/military, you must present a current, valid ID the day of the convention to receive the discounted pricing, If you
do not present a valid ID, you will be charged at the 18+rate.
Maneki Neko Con and PSC reserve the right to revoke your membership and eject anyone at any time from the convention without a refund.
Masquerade tickets will be limited, first come, first serve, to the first 400 attendees to request them at the door.
Circle one per person please.
Saturday pass only
Registration
Month
18+
non-discount
Student/
Military
7-11
Preteen
0-6
Children Sub Total
Feb-May $15 $10 $5 Free
June-Aug $20 $15 $5 Free
Sept. $25 $20 $5 Free $
Month
18+
non-discount
Student/
Military
7-11
Preteen
0-6
Children Sub Total
Feb-May $15 $10 $5 Free
June-Aug $20 $15 $5 Free
Sept. $25 $20 $5 Free $
Month
18+
non-discount
Student/
Military
7-11
Preteen
0-6
Children Sub Total
Feb-May $15 $10 $5 Free
June-Aug $20 $15 $5 Free
Sept. $25 $20 $5 Free $
Month
18+
non-discount
Student/
Military
7-11
Preteen
0-6
Children Sub Total
Feb-May $15 $10 $5 Free
June-Aug $20 $15 $5 Free
Sept. $25 $20 $5 Free $
***GoH Luncheon Quantity x $15 $
****Friday Passes Quantity x $5 $
**Additional donation to support our convention = ___________
**Additional donation to support scholarships = ___________
Grand Total $ _________
**The above two optional donations are tax deductible.
***GoH Luncheon will be limited to the first 30 people.
****You may purchase a Friday only pass, Saturday only, or
both.
Make all checks payable to Prairie State College.
lFor Staff Use Onlyl Grand Total $_________
Cash Check #________ Money Order
Mastercard Visa Discover
Name as it appears on card (please print)
___________________________________________________
Card No. __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
Security code __ __ __ Exp. date __ __ / __ __
Signature __________________________________________
Received by ___________________ Date _________________
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Completed 25 July 2020

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