MOBICON IX Preregistration Form

 

Please PRINT clearly!

 

First Name_____________________ M.I____ Last Name_________________________

Address________________________________________________________________

City________________________ State__________ Zip____________

Birth date (M/D/Y)________________ Age __________Gender________ 

Phone Number _______________________________________________________________

Badge Name (what name you want on your badge?)

____________________________________________________

E-mail address ___________________________________________________________________

Days Attending:  Pre-Reg ___ Weekend ___ Group ___

Guardian Name and Phone Number, if under the age of 18

______________________________________________________________________

 

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 Drugs, nor any member under the influence of illegal substances will be allowed on convention grounds-this includes underage smokers and alcohol abuse by anyone regardless of age.

3.      There will be no smoking except in designated hotel areas or outside.

4.      Along with your badge, you must keep photo ID on your person at all times.

 

For any additional information you may visit the website: www.mobicon.org

 

     I agree to be completely responsible for any and all damage I cause to hotel or convention property.  I further understand that violation of Convention rules will result in the loss of my convention badge and expulsion from the convention events and areas. I also agree to give MOBICON permission to use my picture(s)for use in promotional purposes. I understand that MOBICON will, from time to time, exchange information with area conventions. If you opt out to this please see any member of the registration staff for an opt-out form.

 

Signature___________________________________Date__________________

 

DO NOT WRITE BELOW THIS LINE-STAFF USE ONLY

 

Pre-reg____  Weekend___  Group___                                       Comp___  RPGA___  Guest ___ Other________________

 

Member___  Staff___                   Retailer___ Tables___ Extra Badge(s)________             Amount Paid____________

 

NOTES: Check #___________