Please print out this page and mail it using instructions below.

CHICAGO PEN SHOW 2011
REGISTRATION FORM

Thursday, May 12 to Sunday, May 15, 2011

PLEASE USE THE FORM BELOW TO ORDER YOUR WEEKEND REGISTRATION

Please provide the name and address of each registrant

Name ______________________________________________

Address ____________________________________________

___________________________________________________

Telephone ___________________________________________

Fax ________________________________________________

E-mail ______________________________________________

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___Weekend Registrations, WITH EARLY ADMISSION @ $60 each $ _____

TOTAL $ _______

Please make remittance payable to Chicago Pen Show and send to Daniel A Zazove, Perkins Coie, LLP, 131 S. Dearborn St., #1700, Chicago, IL 60603., U.S.A. Non-U.S. registrants please remit using traveler’s checks or international money order in U.S. Funds.

CLICK HERE to return to Chicago Pen Show web page.