Conzilla — Westercon 59
July 1st through 4th, 2006

San Diego Marriott Mission Valley, San Diego, California

Art Show Application

Please Print Neatly!

Name: __________________________________________________________
(We need your legal name - otherwise, we can't send you a cheque!)

Address: ________________________________________________________

City: ___________________________________________________________

State: _________ Zip / Postal Code: ____________Country: _____________

Phone: _________________________________________________________

E-mail: _________________________________________________________

Agent: _________________________________________________________

URL: ___________________________________________________________

Signature: _______________________________________________________
(I have read the art show rules and agree to abide by them)

_____	4' x 4' pegboard panels @ $20 each	$__________
_____	½ table spaces @ $20 each	$__________	Maximum 2 ½ table spaces
_____	Mail-in artist handling fee @ $5	$__________	only applies to mail-in artists
_____	Mail-in print shop handling fee @ $5	$__________	only applies to mail-in artists
	TOTAL PAYMENT ENCLOSED	$__________	Maximum 3 spaces total

Special Requirements: (electricity, extra lighting, etc. - we will try to accommodate)

_______________________________________________________________

(Please send to (cheques made out to "Conzilla" in U.S. funds):

Conzilla Art Show
PO Box 845
Ramona, CA 92065-0845
United States of America

This reservation will not be accepted unless accompanied by a signed Artist Release & Waiver form