Important, please note: Our privacy policy is simple - we will never sell, display, or show
your personal information to any third party without your prior and explicit approval.
Penguicon uses PayPal to accept on-line registration payment via credit cards or direct funds transfers. No payment will be authorized until you have finished the pre-registration process and have reviewed and confirmed the information.
Please fill in the following information for at least one person (the primary registrant) and up to six people. If you need to register more than six people, please break them up into groups of six or less.
Please note that the fields marked with an *asterisk are mandatory.
Please note that additional registrants after the primary need only fill in a name and birthdate.
Birthdates are a required entry to determine the proper registration fee.
Click any of the "Click Here When Finished" buttons when you are done entering registrants.

Screen: #1 Enter Information- #2 Register - #3 Pay

Primary Registrant (this is the person that gets the confirmation e-mail)

*First name
MI
*Last Name
*Phone Number
( ) -
*E-Mail Address
*Birth Date:
*Address 1
Address 2
*City
 *State/Province
*Zip/Postal Code
 *Country


Pre-registration rates
07/01/03 - 10/31/03
11/01/03 - 01/31/04
02/01/04 - 03/31/04
Regular (18 or older)
$ 30.00
$ 35.00
$ 40.00
Youth (13 through 17 years old)
$ 15.00
$ 20.00
$ 25.00

Primary Registrant's Purely Optional Information
Fen Factor:
Geek Gauge

Please tell us if you'd like to receive additional information concerning:
 
Please tell us where you heard of Penguicon:

Proceed to next page to review entered information.

To add more registrants, scroll down before clicking the button


Registrant #2

*First name
MI
*Last Name
Phone Number
( ) -
E-Mail Address
*Birth Date:

Registrant #3

*First name
MI
*Last Name
Phone Number
( ) -
E-Mail Address
*Birth Date:

Registrant #4

*First name
MI
*Last Name
Phone Number
( ) -
E-Mail Address
*Birth Date:

Registrant #5

*First name
MI
*Last Name
Phone Number
( ) -
E-Mail Address
*Birth Date:

Registrant #6

*First name
MI
*Last Name
Phone Number
( ) -
E-Mail Address
*Birth Date:


Proceed to next page to review entered information.