DRILL order

13X-Day PREREGISTRATION FORM PRINT THIS OUT and MAIL IT, or FAX it, or Copy and Email it. -----------------------------------------------------------------

Name:
Church name:

Address:

City, State, Zip:

Phone:

Email:

Registration Fee (required) Member $30 Non Member $60 ( includes Ordainment/Membership/Fistscription )

Camping Fee (required)
$15/a day
Payable when you arrive

Donation (optional, circle one) Level : Bobby $1 Squid Lover $5 Crusader for "Bob" $10 Slack Master $23 Salesman $50 Yetinsyn $100 Overman/UberFem $999 Other $

My total is:

PAYMENT:

Check or Money Order Payable to : The SubGenius Foundation

PO Box 181417 Cleveland Heights, OH 44118

Credit Card Type:
Acct. Number:
Exp. Date:

Signature:

Send in or fax to (216) 320-9528

THE SUBGENIUS FOUNDATION
PO BOX 181417
Cleveland Heights, OH 44118