Registration for Beach Bash 2004  

          Mundane Name                         Name for ID tag (limit 9 characters)

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(edit this form electronically or continue on back if you have more people)

Mailing Address:

E-Mail Address:

Evening Phone Number:

Registration information postmarked:

$_____  Before 30 June ($25 per person)               Number of people: ___

$_____  Before 30 September ($35 per person)     Number of people: ___

$_____  After 1 Oct ($45 per person)                     Number of people: ___

$_____  Warrior Fee ($5 per competing warrior)**       # of people:   ___

$_____  Invasion Dinner ($20 per person)           Number of people:   ___

$_____  TOTAL AMOUNT OF CHECK           

Number of Klingons wishing to participate in Takeover     ___

** The warrior fee allows you to compete in ALL warrior challenge events FREE of charge !  Only registered warriors are allowed to participate in warrior challenge events.  Everyone is encouraged to participate, however, due to time limitations, we are only able to host 100 competing warriors.

Print this, mail it with your check (made payable to Linda Benedik): Returned checks will incur a $25 bounce-fee.  We will refund money if you have to cancel, as long as you notify us before 30 September.

      Linda Benedik

      P.O. Box 16337

      Atlanta, GA  30321

For additional information - visit our Web Site - http://www.newnanbiz.net/exclusivelyyours/beachbash.html

or e-mail Linda at: hi4lp@yahoo.com

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