| Voter Identification (Please type or print clearly): |
 Name |
| Address |
| Address 2nd line |
| City |
State/Province |
| Country |
Zip/Postal Code |
| E-mail address (optional but STRONGLY recommended) |
| Signature - Unsigned ballots will be considered "No Preference" if otherwise valid |
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Voting Fee (select only one):
| ___ |
Enclosed is a check or traveler's check for US $35 made out to "62nd Worldcon" as my Site Selection Voting fee of the 62nd Worldcon. |
| ___ |
I authorize The Millennium Philcon to charge $35 to my credit card (details in the next column) as my Site Selection Voting fee of the 62nd Worldcon. |
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Eligibility to Vote
You must be an attending or supporting members of The Millennium Philcon to vote:
| ___ |
I am a member of The Millennium Philcon. My membership number is __________ (Your membership number may be found on the mailing labels of our pre-convention publications.) |
| ___ |
I am a member of The Millennium Philcon. In order to be eligible to vote I am purchasing a supporting or attending membership in The Millennium Philcon (see details in the opposite column). |
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| Credit Card Details (Please print or type): |
| _____ Visa _____ MasterCard _____ American Express |
| Name as it appears on the card |
| Card Number |
| Expiration Date |
Cardholder Zip/Postal Code |
| Cardholder Signature |
Date |
|
Millennium Philcon Membership (if required)
Select type of membership desired:
| ___ |
I wish to purchase a supporting membership in The Millennium Philcon for US $40. |
| ___ |
I wish to purchase an attending membership in The Millennium Philcon for US $170. |
|
Select payment method:
| ___ |
My check or traveler's check made out to The Millennium Philcon is enclosed. |
| ___ |
I authorize The Millennium Philcon to charge my credit card. |
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| Polling will close at 6 PM EDT on Saturday, September 1, 2001. Mail-in ballots must be received by August 15, 2001. |
Mailing Instructions:
- Mark your vote on the other side of this sheet. Fill in this side.
- Fold the bottom edge of the ballot up to the line with this side out and tape closed.
- Mail the ballot, and any checks, if necessary, to the Site Selection Administrator at the address listed on the reverse side of this sheet.
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