(PLEASE PRINT)
Name________________________________________________________________________
Name of Business (if applicable) __________________________________________________
Address______________________________________________________________________
City__________________________State_________Zip Code_____________Country_______
Day time Phone#_______________________ Evening Tel.#__________________________
Email Address______________________________________________________________
Convention Fee: $250.00 *No more than 4 registration per envelope***
Make your check or money order payable to: Black Doll Collectors Convention
PO Box 1332
Mansfield, MA 02048
Payments may also be made online using pay pal at paypal.com Visa, MasterCard, Discover and
American Express accepted
If you are an individual with special needs, please contact hotel with the nature and type of
accommodations required.
(Please use back of form, if required. Will note this in our records to assure those with special needs are
appropriately accommodated)
If you are purchasing a T-shirt please indicate what size: S M XL XXL XXXL XXXXL
• Registrations received after February 1,2008 will be assessed a 10.00 late fee
Registrations MUST be sent by regular mail. Any mail received that requires a signature will be refused.
• Registrants must be 13 years of age or older on or prior to May 30, 2008.
• All (3) completed forms MUST submitted.
THE FINE PRINT:
My signature below signifies agreement to and understanding of the following:
• I am or will be 13 years of age or older on or prior to May 30, 2008.
• A $50 service fee will be assessed for each returned check, regardless of the amount of the check.
Services fees for all returned checks must be paid before any further convention communications occurs.
• If I cancel within 30 days of receipt of my completed registration I will be refunded my registration
price of $250.00 less a $50.00 cancellation fee.
• All Cancellations Must be in writing.
• By attending the Black Doll Collectors Convention, I consent to be photographed by means
including, but not limited to, still photography or video recording, and I grant the producer of such photos
and footage, its successors, assigns, publications, carrier stations, network station(s), sponsor(s) of the
program and advertising agents (as well as their affiliated and related entities) the right to record and use
your name, voice, and likeness worldwide in perpetuity for any purpose whatsoever.
• The 2008 Black Doll Collectors Convention is being held in Mansfield, Mass and any action
pertaining to the terms and conditions of this contract will have Mansfield, Mass as its venue.
Signature_______________________________________________________Date_________________
______
(Signature of parent or legal guardian if registrant is under the age of 18 on date of signing)
Please do not write below this line
CK #________________________Amount_________________
The Legend of Cecilia and associated trademarks and trade dress are owned by and used under license
from The Doll E. Daze Project and Museum Inc. ©, Wrap Doll Studios Inc. ® All Rights Reserved.
*PLEASE Make three copies of this form. Keep one for your copy and send us the remainder two***
Name________________________________________________________________________
Name of Business (if applicable) __________________________________________________
Address______________________________________________________________________
City__________________________State_________Zip Code_____________Country_______
Day time Phone#_______________________ Evening Tel.#__________________________
Email Address______________________________________________________________
Convention Fee: $250.00 *No more than 4 registration per envelope***
Make your check or money order payable to: Black Doll Collectors Convention
PO Box 1332
Mansfield, MA 02048
Payments may also be made online using pay pal at paypal.com Visa, MasterCard, Discover and
American Express accepted
If you are an individual with special needs, please contact hotel with the nature and type of
accommodations required.
(Please use back of form, if required. Will note this in our records to assure those with special needs are
appropriately accommodated)
If you are purchasing a T-shirt please indicate what size: S M XL XXL XXXL XXXXL
• Registrations received after February 1,2008 will be assessed a 10.00 late fee
Registrations MUST be sent by regular mail. Any mail received that requires a signature will be refused.
• Registrants must be 13 years of age or older on or prior to May 30, 2008.
• All (3) completed forms MUST submitted.
THE FINE PRINT:
My signature below signifies agreement to and understanding of the following:
• I am or will be 13 years of age or older on or prior to May 30, 2008.
• A $50 service fee will be assessed for each returned check, regardless of the amount of the check.
Services fees for all returned checks must be paid before any further convention communications occurs.
• If I cancel within 30 days of receipt of my completed registration I will be refunded my registration
price of $250.00 less a $50.00 cancellation fee.
• All Cancellations Must be in writing.
• By attending the Black Doll Collectors Convention, I consent to be photographed by means
including, but not limited to, still photography or video recording, and I grant the producer of such photos
and footage, its successors, assigns, publications, carrier stations, network station(s), sponsor(s) of the
program and advertising agents (as well as their affiliated and related entities) the right to record and use
your name, voice, and likeness worldwide in perpetuity for any purpose whatsoever.
• The 2008 Black Doll Collectors Convention is being held in Mansfield, Mass and any action
pertaining to the terms and conditions of this contract will have Mansfield, Mass as its venue.
Signature_______________________________________________________Date_________________
______
(Signature of parent or legal guardian if registrant is under the age of 18 on date of signing)
Please do not write below this line
CK #________________________Amount_________________
The Legend of Cecilia and associated trademarks and trade dress are owned by and used under license
from The Doll E. Daze Project and Museum Inc. ©, Wrap Doll Studios Inc. ® All Rights Reserved.
*PLEASE Make three copies of this form. Keep one for your copy and send us the remainder two***
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Doll E. Daze Project
DALLSS Inc.org
Black Doll
Collectors Convention
On line Registration Form
Reg.#___________
May 30-June 1, 2008
Mansfield, Mass
Mansfield, Mass
2008 Convention Package
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