Costume Title: _____________________________________________________________________________

I/We have read and understood the rules of the Costume-Con 25 Masquerade and agree to abide by them.  
Further, I/we agree to permit photography and/or videotaping and also agree to permit the use, sale, and/or 
dissemination of said photographs and/or videotapes subject to permission from the Costume-Con 25 Committee.  
Further, I/we agree to hold the convention, its organizers, and the facility both severally and individually blameless 
for any accident and/or injury suffered by me/us during the course of this Masquerade except in cases of gross 
negligence on the part of those cited above.

____________________________________		__________________________________
Print name						Signature

Date: ____________________

If this is a group entry, we must have signatures from all entrants.  
(Group members may sign different release forms; each form must have the costume title entered above.)

If entrant is a minor, parent or guardian must sign the release.

_________________________________________		_______________________________________
Print name						Signature

Legal Guardian of (Name of Minor)_______________________________________________________________

Contact Information
Contact Name: _________________________________________	Phone: _________________________

Mailing address: ________________________________________________________________________

City: ____________________________  State/Province: __________ Zip/Postal Code: _______________

E-mail: ________________________________________________________________________________

Contact Info at Costume-Con 25
Hotel room #: _______________________ or Local Address: ____________________________________

Cell Phone or other contact number: ________________________________________________________