Please note: We cannot process online registrations. Please print out this registration form and send it, with your registration check, to: FTMCLA/P.O. Box 922342/Sylmar CA 91392-2342

Name:__________________________________________________

Mailing address:_________________________________________

City, State, Zip:__________________________________________

Country (if outside USA):_________________________________

Telephone:______________________________________________

Additional registrants (same address):______________________

________________________________________________________

________________________________________________________

Name for badge:__________________________________________

E-mail address:__________________________________________

I'd like to volunteer! Area(s) I can help in are:_______________

________________________________________________________

I have Special Needs (i.e., Sign Language interpreters, wheelchair access,

child care, etc. Please be specific)

______________________________________________________________________________

__________________________________

Registration fees:

$ 60 - Postmark by 6/30/99

$ 90 - Postmark 7/1/99 - 9/15/99

$125 - at the door Friday

$ 75 - at the door Saturday

$ 25 - at the door Sunday

__ Medium

__ Large

__ X-Large

__ XX-Large

FTMCLA
P.O. Box 922342
Sylmar CA 91392-2342

I would like to make this Conference happen and help others attend by my   additional donation of $________. (Thank You!)

Help! I may need financial assistance. I can only afford to pay $_________.

__ I am planning to stay at the Burbank Hilton for ____ nights.

Refund Policy: (must be cancelled in writing)
100% if postmarked by 8/30/99
50% if postmarked by 9/30/99

Bad Check Policy:
Writers of bad checks will be liable for all applicable bank charges.