Potlatch 5 Membership Form

Memberships in Potlatch 5 are:

$35 through January 15, 1996;
$40 at the door.

Supporting Memberships cost $15 at all times. A supporting membership gets you all convention publications and a warm fuzzy feeling.

Sunday Brunch is $13.25 including gratuity.

Please print out this form, fill it out, and mail it with your payment to:

Potlatch 5
c/o OSFCI
PO Box 5703
Portland, Oregon 97228-5703

Please make checks payable to "Potlatch 5".

List any additional names and addresses on the back or on a separate sheet.

I enclose $______ for ______ membership(s) and ______ brunch(es).

Name _____________________________________________________________

Address __________________________________________________________

City/State _______________________________________________________

ZIP/Postal Code __________________  Phone ________________________

E-Mail Address ___________________________________________________

Please tell us where you found out about this Web page:

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Programming suggestions and comments:

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