Noreascon Four

PO Box 1010
Framingham, MA 01701 U.S.A.
fax: +1 617.776.3243





We send copies of our publications to each member [excluding children's admissions].
[ ] Check here if you prefer to receive only one copy for your household.




All members on this form must be at the same address. Please circle the names of children for whom you are purchasing a child's admission.


City _____________________________ State ____________ Zip/Postal _______________

Country _____________ Telephone _________________ Email ______________________

Check here if this is a new address:  [ ]

I'd like information about: [ ] Volunteering to help

Membership Rates August 1, 2004 until September 3, 2004

Attending Upgrade Supporting Installment Child's*
(__) $200 (__) $165 (__) $35 (__) $_____ (__) $100

Indicate number of each type of membership being purchased in the space provided above.
Please note that voter and pre-support discounts expired February 28, 2002, and no longer apply.

I am buying _______ total memberships for a total of $_______. I am paying by (circle one):

Visa MasterCard Check [Make checks payable to Noreascon 4]

Card #_________________________________ Exp._________

Name on card ________________________________________

Signature ___________________________________________

*A Child's admission includes 6 hours of childcare, on a space-available basis. Children's admissions do not include publications or voting rights for the 65th Worldcon site selection. Children must accompany an attending member and be 12 years of age or under as of Sept. 6, 2004. This applies only to a child's admission; children who are attending members have full voting rights.

"Worldcon," "World Science Fiction Convention," and "Hugo Awards" are registered service marks of the World Science Fiction Society, an unincorporated literary society. "Noreascon" is a registered service mark of Massachusetts Convention Fandom, Inc.