Bastards by the Bay Conference Registration Form

Come join the fun, education and empowerment at

Bastard Nation's Second Annual Conference!
July 17 - 19, 1998
Radisson Miyako Hotel San Francisco, California

Conference Registration fee:

Name_____________________________________

Email Address____________________

Address__________________________________

Apartment #____

City__________________________

State/Province _________

Zip Code_______________

Country________

Phone number: (     ) ______________________

Are you a BN member? Yes_____ No _____

If so, what category? _________________

Payable by check to Bastard Nation.

Credit Card: Bastard Nation accepts the following credit cards:

Visa _______ Master Card ______ American Express_____

Name as it appears on the credit card

_____________________________________________

Expiration date __________________________

Signature ___________________________________________

Send your payment and registration form to:

Bastard Nation
P.O. Box 1469
Edmond, OK 73083-1469

You can also fax your registration to 415-704-3166. Include your credit card number, expiration date and the full name as it appears on the credit card in the form above if you would like to pay by credit card.

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