Membership Form:

Yes! I want to join InterContact

I want a full/children's/supporting membership *circle where appropriate - one form needs to be filled out for each membership)

Medlemspriser/membership rates
Vanlig/barn/under 5/støttemedlemskap
Attending/child/under 5/supporting
NOK 250/125/50/50
GBP 20/10/5/5
USD 30/15/6/6
Send check or money orders in Norwegian kroner only, please

My Name is          _________________________________________________

My badge name is    _________________________________________________

I live at           _________________________________________________



My phone numbers is _______________ E-mail __________________________

I would like Intercontact to find me a place to crash        - yes/no

(the convention will contact you in 1998 to find out your exact dates)

I am interested in gophering - yes/no

I would like to work with __________________________________/anything

I have an item for a programme item!

I'd like to organize it myself/I'd like the InterContact

programme group to organize it

My idea is:         ________________________________________________


            (The programme group will get in touch with you)

I would be interested in using the creche facilities         - yes/no

InterContact '98
Box 121 Blindern
N-0313 Oslo

Acc # 0807 214 4954

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