DONBURA CON CRUISE APPLICATION
Nippon 2007 / The 65TH Worldcon / The 46TH Japan SF CON

Date of Application (d/m/y):	
APPLICANT’S INFORMATION (Please print clearly):	
Surname/Family Name:	
First Name/Middle Initial:	
Address Line 1: 		
Address Line 2:		
City or Town: 		
State or Province:		
Postal Code:		
Country:			
Group or Circle Name (If any):	
Male      Female	  
Membership Number:	
Attending / Supporting  ?
1. Telephone:		
2. FAX Phone:		
3. Cell Phone:		
4. E-mail:			
Preferred contact method?  (Phone/Fax/Cell/Email/Post)  
Best contact between        o’clock and        o’clock      Time Zone      
EMERGENCY CONTACT (Required):
Surname/Family Name:	
First Name/Middle Initial:		
1. Telephone:		
2. FAX Phone:		
3. Cell Phone:		
4. E-mail:			
Relationship to you:	
Address Line 1: 		
Address Line 2:		
City or Town: 		
Province or State:		
Postal Code:		
Country:			

ADDITIONAL PERSONS WITH APPLICANT (If not enough space for all of the people in your group or circle, please add the additional information on a separate sheet, or use a second copy of the form.  Please be sure to put your contact information on each sheet if you mail the form.):

Surname/Family Name:	
First Name/Middle Initial:	

Surname/Family Name:	
First Name/Middle Initial:	

Surname/Family Name:	
First Name/Middle Initial:	

Surname/Family Name:	
First Name/Middle Initial:	

Surname/Family Name:	
First Name/Middle Initial:	

PAYMENT COMPUTATION (No charge for Guests of Honor and spouses, Hugo Winners, or for pre-school children.):
Adults (Number):			#	x   8,400 Yen =		Yen
High/Middle School Students:	#	x   4,200 Yen =		Yen
Elementary School Students:	#	x   3,400 Yen =		Yen
Grand Total:									Yen

PAYMENT:   Credit Card Type:			Expiration Date:  
Full Name on Card:			
Card Number (and code if used):	
We will send you a confirmation by email.  Please print out the email and bring it with you, it is your voucher to exchange for the boarding pass.  You may also pay via the Japanese Post Office postal transfer service;  see Progress Report 5 for instructions.

Please send the completed form to nippon2007@donbura.com. Please fill in all the required spaces. All of the information marked  "required" is needed before your application can be processed. We will try to
accommodate all requests, but please understand that we may not be able to do so. In addition, there may be minor changes made to the cruise. If we have not replied within one month after you have mailed your
application, please inquire to ikeda@bukimi.com. We regret any inconvenience.

Please make check out to "Nippon 2007" 
Mail check and the completed form to

Bob MacIntosh
Donbura_con/Nippon 2007
7113 Wayne Drive
Annandale, VA 22003_1734

May we send this information to the next convention?  Yes / No	

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