On-line Registration

First Name *

Last Name *

Badge Name *

Age *

Address *

State *

Zip code / Postal code *

Country *

E-mail address *

E-mail address (once again) *

Membership Type *

Attending Members from overseas

Attending

Supporting

Student

Married couples

Child: under elementary school

Include my name in HAL-CON Japan publicity and Web-Site

Yes

No

Volunteer

Yes

No

Comment

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