ONLINE REGISTRATION

Name:
eMail:
Street Address:
City:
State:
Zip Code:
Phone (daytime):
Phone (after 6PM):

Type of Membership
$40.00 Complete Membership (entitles you to play in all events, tournaments and LARPs available at Southern Exposure II)
$30.00 Visiting Membership (allows access to fixed functions ONLY, such as the Con Suite and the Dealers' Room, and is designed for Spouses, Parents, etc.)

SPECIAL DISCOUNT CODE Some groups have been given special codes which result in a discount on their individual Southern Exposure II memberships. If you are in such a group, please enter the code here and then adjust the amount you are paying appropriately.
Discount: $

Southern Exposure II T-Shirt (add $10.00 to your payment)
Small
Medium
Large
X-Large
2XL
3XL
None

Have you ever been to a Double Exposure event before?
Yes
No

Would you like to be added to our eMail announcement list? (Note: ONLY Double Exposure uses this list, your eMail address will NEVER be given to any other organization!)
Yes
No

Please choose a method of payment:

Credit Card via Secure Server: Once you submit this completed page, you will be given the opportunity to enter your credit card information on our Secure Server. Please note that it is YOUR responsibility to enter the correct amount to be charged AND to explain in the "Notes" field below if there is any discrepancy between the credit card authorization and the person who is actually registering (i.e. Jane Doe is paying for her son, John Doe).
Check: Once your form is accepted, we will give you instructions on where to send the check. Please note that unlike the credit card method, you will NOT be considered registered for Southern Exposure II until your check clears.

Notes (please use this field to enter Discount Codes or any other information which deviates from the norm):