Warpstock 2000, Philadelphia Holiday Inn, Independence Mall September 9-10, 2000. __________________________ MAIL-IN REGISTRATION FORM To mail in your registration, please fill out this form and send it in with a check or money order MADE OUT TO "WARPSTOCK, INC." Send it to the following address: Warpstock 2000 - C/O Stan Sidlov 187 Hilltop Court Pompton Lakes, New Jersey 07442 United States of America Please note that August 31st, 2000 is the cut-off date for mail-in registrations. NAME : ___________________________________________________________________ E-MAIL : _________________________________________________________________ STREET ADDRESS : _________________________________________________________ CITY : ___________________________________________________________________ STATE OR PROVINCE : ______________________________________________________ POSTAL CODE : ____________________________________________________________ COUNTRY : ________________________________________________________________ NR OF REGISTRATIONS ($79 until 08-31-00, $99 afterwards) : _______________ NR OF SOCIAL EVENT ($40 per person, tax & service included) : ____________ What would you like to have printed on your Warpstock badge ? BADGE 1 NAME : ___________________________________________________________ CITY, STATE : ____________________________________________________ INFO : ___________________________________________________________ BADGE 2 NAME : ___________________________________________________________ CITY, STATE : ____________________________________________________ INFO : ___________________________________________________________ ********************