Legal Name:
Date of Birth (MM/DD/YYYY):			Age:	Gender:	M F
Legal Guardian Name (if under 18):
Legal Guardian Phone Number:		( )
Company/Artist Group Name:
Badge Name:
Street Address:
City:
State:	Zip Code:
Phone:
E-Mail:
Website:

MOBICON Rules of Conduct

1. Your badge must be visible at all times. Badges must be worn above the waist and to the front of your body. A replacement badge will cost $5.00 for the first then full cost for admission after that.
2. No illegal substances or any member under the influence of such will be allowed on the premises. This includes underage smoking, underage drinking and alcohol abuse by anyone regardless of age. Hotel security reserves the right to remove members independent of the convention.
3. Smoking is only permitted outside or in designated hotel areas.
4. You must have photo identification on your person at all times.

		Staff Use Only Check Number
Artist’s Alley @ $75.00 (1/2 of 6’ table), max. 2	$
MOBICON T-Shirt @ $15.00 each	$
Total:	$

Please make checks/money orders payable in U.S. Dollars to MOBICON.

Mail Registration Form & Payment to:

MOBICON

Attn: Registration

P.O. Box 161632

Mobile, AL 36616-2632

I have read and agree to all rules of the MOBICON Convention and Art Show. I agree to be completely responsible for any and all damage I cause to hotel or convention property. I further understand that any violation of MOBICON rules will result in the loss of my membership badge and expulsion from the convention events and areas. I give MOBICON permission to use my likeness in promotional materials in any media currently available or not yet invented. If you choose to opt out of the use of your likeness for promotional purposes, please see any member of the Registration Staff for an opt-out form.

Signature:

Date: