REGISTRATION for the INTERNATIONAL CONTORTION CONVENTION 2000 ------------------------------------------------------------- Las Vegas NV, USA -- Sept 10-13, 2000 To register for this event and pay the registration fee and optional fees, please PRINT OUT, complete this form, SIGN and send it ... BY MAIL to : or BY FAX to : T:mi Softronic +358 - 9 - 2983308 PL 97 02101 Espoo (Finland) Customer information: Name: ______________________________________________________ Address: ______________________________________________________ City: ______________________________________________________ State/Province: ______________________________________________________ Zip/Country: ______________________________________________________ Phone: _____________________ Fax: ________________________ E-mail: ________________________ Important information: Your credit card will be charged in EURO because Ron Dwight's company T:mi Softronic is located in Finland. Please understand that the name T:mi Softronic will appear on your credit card bill. However - Ron is not making profit from this - it's only for the ICC. This payment option is valid thru July 31, 2000. Please do not use this form afterwards. Please mark the options you wish to pay for : No. of persons ----------- Convention registration fee ... (ca. 175 US$) = ______ * 190 EUR Photo pass (still picture only) (ca. 30 US$) = ______ * 32 EUR Video pass (stills+videotaping) (ca. 50 US$) = ______ * 54 EUR Gala event entrance fee ....... (ca. 20 US$) = ______ * 22 EUR Credit card surcharge ......... (ca. 10 US$) = 1 * 10 EUR Total Credit card (Visa, Eurocard, OK = or Mastercard) ________________ EUR (please fill in) Credit card account: (__) Visa (__) Eurocard Card number: (4 digit groups) (__) OK (__) MasterCard ________ ________ ________ ________ Expiration date _____ / ____ month year Please don't forget to sign at the end of this form. Date: ___________ SIGNATURE: _____________________________________ Name of card holder in block capitals: _________________________________