NAME OF COMPANY OR INDIVIDUAL: ________________________________

ADDRESS: ____________________________
                    ____________________________

TELEPHONE:

BUSINESS: ________________________
HOME:        ________________________
CELL:          ________________________
FAX:            ________________________
E-MAIL:      ________________________

Number of Tables:

_____ WALL TABLES -$175.00
for LAST YEAR’S wall table holders only;                    Total: $_______
(If you are interested in a wall table, please reserve
an interior table and request to be on our waiting list)

_____ INTERIOR TABLES - $125.00 each;                   Total $_______

ASSISTANTS: NOTE, there is no charge for a NON-COLLECTOR ASS’T.;
COLLECTOR ASSISTANTS ARE EACH CHARGED $60.00;

1ST ASSISTANT: Name:___________________; Address:______________________

2ND ASSISTANT: Name: __________________; Address: ______________________

3RD ASSISTANT: Name: __________________; Address: ______________________

Number of Collector Assistants at $60.00 each _______    Total $_______

Note that there is no guaranty of electricity hookups. Wall table holders will be able to use extension cords if necessary to plug into wall outlets as will wall table holders in the front hall outside the main ballroom.

Please make remittance payable to the Chicago Pen Show and send to Daniel A. Zazove,
Perkins Coie, LLP, 131 S. Dearborn St., #1700, Chicago, IL 60603. Non-US registrants please remit
using international money orders in U.S. funds or make arrangements with the organizers to pay upon arrival.