Membership Services: Registration Form
Use your browser’s print function to print the registration form.
If you only have one name (e.g. "Cher" or "Madonna") then please use the Surname field.
All fields with asterisks (*) are required fields. If you leave them blank you will not be able to register.
Given Name:
Middle Name/Initial:
* Surame:
Badge Name:
(Leave blank if you want the legal name to be the badge name.)
* Street Address:
* City:
* State/Province:
* Zip/Postal Code:
* Country:
Home Phone:
Other Phone:
E-mail Address:
(If this membership is for a child under 13 years, please enter in a guardian’s e-mail address instead.
Would you like to be added to the Rustycon Members e-mailing list? (circle) Yes No
(No spam, we promise - just Rustycon Announcements and such)
* Is the attending member 18 or older? (circle) Yes No
Would you be willing to volunteer to help us at Rustycon? (circle) Yes No
If so in what areas would you like to assist:
Membership type (circle): Adult $30 Teen 13 - 17 $30 Child 6 - 12 $15
Guardian Name:
Guardian Signature:
The guardian whose name is listed here will be REQUIRED to sign a release form when the child/teen picks up their badge. Signing this form also indicates that the person responsible has read and agrees to Rustycon’s policies on minors attending the convention. This registration form must be signed or the child/teen’s registration WILL NOT be processed.
Make checks and money orders payable to:
Rustycon 26P.O. Box 27075
Seattle, Wa 98165-1475