Please use a separate form for each person registering. Copy this form if necessary. Make checks or money orders payable to A.C.E. (U$ funds ONLY) - Please print legibly. DO NOT mail registration forms after July 01, 2001. After that date you must pay at the door.
Legal Name_________________________________________(Age, if Minor*)______
Street______________________________________________________________
City_______________________________ State_____________ Zip_____________
Phone: Day ( ) ______________________ Evening ( ) __________________________
E-mail ____________________________ URL _____________________________
*Minors (under 18) MUST be accompanied by parent or legal guardian
| A.C.E. Annual Membership | (Members discount does apply to this year) . . . $65: | |
| Members postmarked on or by June 30, 2001 $100: | ||
| At the door (Cash or money order only) . . . . . $140: | ||
| Non-Members | Postmarked on or by June 30, 2001 . . . . . . . . . $140: | |
| At the door (Cash or money order only) . . . . . $180: | ||
| Child (5-15) | $40: | |
| Merchant Fee | (See Attention Merchants for info). . . . $55: |
Please include your merchanting name and product(s)/service for license _______________
__________________________________________________________________
Ad or coupon space in the Starwood Tour Guide (approx. 50-page catalog with print run of 2000)
| Ad sizes: | Quarter page (3.75"x2.5") or Business Card (3.5"x2") . . $50: | |
| Half (3.75"x2.5") . . $80: | ||
| Full (5"x8") . $150: |
| African Drumming & Dancing with Amanpondo . . . . . . . . . . . . . . . . . . . . . . . $20: | |
| Live Action Role Playing (www.rosencomet.com/starwood2001/LARP). . . . $20: | |
| Drum Making and repair Workshops:
Contact Alex & Joy Wedmedyk by July 1st at 330.273.6260 or ERhythmn@aol.com for workshop & materials fees to make Djembe & Ashiko Drums (large or small) and Hoop drums. |
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| Total Enclosed for Starwood XXI: |
You may now pay with either VISA or MasterCard. Please fill out
the following information or charge by phone by calling the numbers below. Specify
which card (circle logo)
Card #: ____________________________ Expiration Date: ____________________
Signature: __________________________ Zip Code of Cardholder: _______________
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Please make checks payable to A.C.E and send to: |
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| Association for Consciousness Exploration Attn: Registration, 1643 Lee Road, #9 Cleveland Heights, OH 44118 |
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216.932.5421 800.446.4962 Fax: 216.932.4973 |