Fan Gallery Caption Info

Rev. 16-Oct-2002

CAPSULE BIO FORM

NAME: (First name) (last name)

E-mail address:

Birthdate:

Current Locale:

Category or categories (e.g. Convention fan, Club fan, Fanzine archivist, Musician, Fan editor, etc.):

FGoH (or other GOH, please specify):

Con Committees:

Awards & Honors:

Clubs/Offices:

Fanzines:

Other Fanac:

First contact with fandom (year):

May we put your photo on our web site?

Photographer
Month/Year: