CONVENTION REGISTRATION APPLICATION Registration fee is $85.00/person

Names________________________________ Email__________________________

Address_______________________ City_________________ State_____ Zip________

# Persons____ X $85 $ _______

# Early Bird Badges ____ X $5 = _____ (Optional – first 25 registrants)

Total Enclosed $______ (Payable to R. A. Fox Society)

Send payment w/application to: Darlene Krozel, 202 Hollow Way, Ingleside, IL 60041

Will be selling?____yes ___no

Will donate prints to auction?_____yes _____no