Name:		__________________________________________________

Badge Name:	__________________________________________________

Address:	__________________________________________________

		__________________________________________________

Age:	___________ E-mail: ____________________________________


Do you have any special needs? 

If so please give details on reverse of page when printed.

Are you registered with Electrical Eggs UK? 	YES / NO
__________________________________________________________________
Membership Type			£ Stg. 	Euros 
__________________________________________________________________
Weekend (Adult)			£15	[ ]	24	[ ]
->[before 31st October 2002]	£13	[ ]	20	[ ]
Weekend (Minor)			£9	[ ]	14	[ ]
Saturday Pass (Adult)		£10	[ ]	17	[ ]
Sunday Pass (Adult) 		£7	[ ]	12	[ ]
Saturday Pass (Minor)		£7	[ ]	12	[ ]
Sunday Pass (Minor)		£5	[ ]	8	[ ]
Supporting				£5	[ ]   8	[ ]
__________________________________________________________________

Are you interested in stewarding over the weekend? YES / NO

Please list 3 songs you would like to hear at the disco:

1. _______________________________________________________________

2. _______________________________________________________________

3. _______________________________________________________________

If you require a receipt please enclose a S.A.E.
All cheques should be made payable to "QUB Sci-fi & Fantasy 
Society". Please do not send cash through the post.

Please post this form to:	Mecon 6 Reg
				   12 Hopefield Avenue,
				    Belfast, BT15 5AP